Network Quality Manager

Medata Inc.; California; On-site; USD 105,000 - 130,000; Full time

Job summary

Medata Inc. is seeking a strategic Network Quality Manager to oversee provider network performance with a strong emphasis on dispute avoidance, dispute resolution, and risk mitigation within the workers’ compensation bill review process.

You will serve as the central point for provider reimbursement disputes, ensuring alignment with contracts and regulatory expectations while reducing dispute volume and protecting financial and reputational risk.

Qualifications

• 7-10 years of experience in Network Management or related field.
• Experience with bill review disciplines and provider reimbursement disputes.
• Strong written and verbal communication skills.
• Experience in a matrixed organization with multi-stakeholder management.

Responsibilities

• Oversee provider network performance with focus on dispute avoidance and risk mitigation.
• Act as central point for provider reimbursement disputes and ensure compliance with contracts and regulations.
• Collaborate with legal, clinical, and compliance teams to resolve disputes efficiently.

Skills

Network management

Dispute avoidance

Stakeholder management

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Network Quality Manager

Full Time Regular Professional Conshohocken, PA, US 1 Attachments

3 days ago Requisition ID: 2920

Salary Range: $105,000.00 To $130,000.00 Annually

Who We Are

We’re a group of talented, driven professionals who strive every day to improve the lives of our clients, our providers and the ultimate stakeholders – the injured workers. We offer an exciting workplace environment plus competitive salaries and benefits. What makes us stand out? It’s the people, the culture we foster and the opportunity to learn and to grow.]

Job Summary

We are seeking a strategic, analytical Risk Manager to oversee and optimize provider network performance with a strong emphasis on dispute avoidance, dispute resolution, and risk mitigation within the workers’ compensation bill review process.

In this role, you will act as the central point of accountability for provider reimbursement disputes, ensuring network partners operate in alignment with contractual, regulatory, and operational expectations. You will collaborate closely with internal stakeholders, provider networks, and clients to reduce dispute volume, improve resolution outcomes, and protect financial and reputational risk while maintaining high service quality.

Primary Duties & Responsibilities

• Develop and enforce network policies and workflows to provider reimbursement disputes related to PPO discounts, provider contracts, and post-bill review reductions.
• Analyze provider appeals and adjustments to identify trends and root causes, recommending data-driven improvements.
• Collaborate with legal, clinical, and compliance teams to resolve provider disputes efficiently and consistently.
• Promote proactive communication with providers to enhance understanding of reimbursement processes and reduce conflict.

Performance Measurement & Optimization

• Design and maintain network performance dashboards tracking metrics.
• Collaborate with analytics teams to evaluate network quality, effectiveness, and impact on claims outcomes.
• Own the lifecycle of network-related solutions that enhance compliance, savings, and stakeholder satisfaction.
• Translate client requirements and regulatory changes into actionable product improvements.
• Monitor market and regulatory trends to guide product innovation and maintain competitive advantage.

Cross-Functional Leadership & Collaboration

• Serve as the subject matter expert on network products, provider performance, and dispute processes.
• Partner with internal teams—including sales, account management, RFPs, and product launches.
• Collaborate with external vendors and partners

Qualifications

• 7-10 years of experience in Network Management and or Group Health?
• Experience working in or with Bill Review disciplines
• Strong written and verbal communications
• Experience working in a matrixed organization and effective with multi-stakeholder management
• Excellent relationship management and issue resolution skills
• Enjoys managing talent at all levels; familiarity working with offshore teams a plus
• Excellent organizational, analytical, and communication skills.

Working Conditions & Physical Requirements

• The work environment characteristics described here is representative of those of a standard office setting. The noise level in the work environment is usually moderate.
• The work environment characteristics described here is representative of those of a standard office setting. The noise level in the work environment is usually moderate.
• While performing the duties of this job, the employee must be able to remain in a stationary position over 50% of the work day; move about inside the office to access files or office equipment; use hands to finger, handle, or feel objects, tools, or controls to operate a computer and other office productivity machines; reach with hands and arms; must communicate and converse with co-workers; and detect/discern information accurately. Specific vision abilities required by this job include close vision and the ability to adjust focus. The employee must occasionally lift and/or move up to 10 pounds.
• While performing the duties of this job, the employee must be able to remain in a stationary position over 50% of the work day; move about inside the office to access files or office equipment; use hands to finger, handle, or feel objects, tools, or controls to operate a computer and other office productivity machines; reach with hands and arms; must communicate and converse with co-workers; and detect/discern information accurately. Specific vision abilities required by this job include close vision and the ability to adjust focus. The employee must occasionally lift and/or move up to 10 pounds.