Description
Position Purpose:
Leads the organization's No Surprises Act (NSA) Independent Dispute Resolution (IDR) operations, ensuring compliance with federal and state regulations while driving operational performance, dispute resolution effectiveness, and financial stewardship. Manages teams, processes, resources, and cross-functional partnerships to support high-volume arbitration activities, regulatory readiness, and continuous process improvement.
Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
- Lead and manage NSA IDR operations, ensuring timely, accurate, and compliant handling of federal and state dispute resolution activities.
- Oversee end-to-end IDR case administration, including dispute initiation, review, submission, determination, payment resolution, and case closure.
- Direct operational performance by managing inventory, productivity, quality, service levels, and regulatory timelines in a high-volume environment.
- Lead, develop, and manage staff and contracted resources, including workforce planning, coaching, performance management, and resource allocation.
- Monitor and analyze operational and financial performance metrics, identifying trends, risks, and opportunities to improve outcomes and efficiency.
- Ensure compliance with federal and state regulations by maintaining effective controls, documentation standards, policies, and audit readiness.
- Manage arbitration-related financial activities, including fees, payment determinations, reconciliations, and financial exposure tracking.
- Collaborate with Legal, Compliance, Regulatory Affairs, Claims, Provider Operations, Finance, and other stakeholders to resolve complex disputes and implement regulatory changes.
- Lead operational readiness and process improvement initiatives, including regulatory implementations, workflow enhancements, system changes, and training efforts.
- Prepare and present operational updates, performance results, risks, and recommendations to leadership and cross-functional partners.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience: Bachelor's Degree in Healthcare Administration, Business Administration, Health Policy, Public Administration, Finance, related field or equivalent experience required. 5+ years in healthcare operations, claims, provider reimbursement, appeals and grievances, regulatory operations, compliance, dispute resolution, or a related healthcare function required. 2+ years management experience previous people leadership and supervisory experience, including hiring, onboarding, training, work assignment, coaching, performance management, and employee development, with a proven ability to lead and motivate teams in a high-volume, fast-paced operational setting required. 3+ years managed care or health insurance experience required. Experience with the No Surprises Act, Federal or state IDR, open negotiation, surprise billing requirements, CMS regulatory implementation, or related dispute-resolution operations preferred.
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
