Network Quality & Dispute Risk Manager

MedRisk LLC; West Conshohocken (PA); On-site; USD 105,000 - 130,000; Full time

Job summary

MedRisk LLC in Conshohocken, PA seeks a Network Quality Manager to oversee provider network performance with a strong emphasis on dispute avoidance, dispute resolution, and risk mitigation within workers’ compensation bill review. You will be the central point of accountability for provider reimbursement disputes, ensuring network partners align with contracts and regulatory expectations.

You will collaborate with internal stakeholders, provider networks, and clients to reduce dispute volume,

Qualifications

• 7–10 years of experience in network management or group health.
• Experience with bill review disciplines.
• Excellent written and verbal communications.
• Experience in matrixed organizations and multi-stakeholder management.
• Strong relationship management and issue resolution skills.
• Experience managing talent, including offshore teams is a plus.
• Excellent organizational, analytical, and communication skills.

Responsibilities

• Develop and enforce network policies and workflows related to provider reimbursement disputes.
• Analyze provider appeals and adjustments to identify trends.
• Collaborate with legal, clinical, and compliance teams to resolve disputes.
• Promote proactive communication with providers to reduce conflict.
• Design and maintain network performance dashboards.
• Collaborate with analytics teams to evaluate network quality and claims outcomes.
• Own lifecycle of network-related solutions to improve compliance and savings.
• Translate client requirements and regulatory changes into product improvements.
• Monitor market and regulatory trends to guide product innovation.
• Serve as subject matter expert on network products and dispute processes.
• Partner with internal teams including sales, account management, RFPs, and product launches.
• Collaborate with external vendors and partners.

Skills

Network Management

Group Health

Data Analysis

Stakeholder Management

Dispute Resolution

Job description

MedRisk LLC in Conshohocken, PA seeks a Network Quality Manager to oversee provider network performance with a strong emphasis on dispute avoidance, dispute resolution, and risk mitigation within workers’ compensation bill review. You will be the central point of accountability for provider reimbursement disputes, ensuring network partners align with contracts and regulatory expectations.

You will collaborate with internal stakeholders, provider networks, and clients to reduce dispute volume,