Provider Dispute Resolution Lead — AI-Driven Ops

Zelis; Town of Florida (NY); Hybrid; USD 140,000 - 190,000; Full time

Job summary

Zelis is hiring a Manager, Provider Dispute Resolution to lead Federal IDR and Out of Network Post Pay operations, ensuring quality, productivity, and compliance while driving AI-enabled improvements and workforce development.

You will partner with Product, Technology, and Client Management to enhance performance, scalability, and customer outcomes, building high-performing teams and a culture of accountability.

Qualifications

• Bachelor's degree in a related discipline, or equivalent combination of experience.
• 8+ years of progressive healthcare operations experience in claims, provider dispute resolution, payment integrity, revenue cycle, or related healthcare operations.
• 5+ years of people leadership experience managing operational teams and business performance.
• Strong analytical skills with the ability to leverage operational data to identify trends, solve complex problems, and drive informed business decisions.
• Excellent communication, presentation, and stakeholder management skills with the ability to influence cross-functional teams.

Responsibilities

• Lead the day-to-day operational execution of Federal IDR and Out of Network Post Pay functions, ensuring achievement of quality, productivity, compliance, financial, and service-level objectives.
• Develop and execute operational plans that improve business performance, customer experience, operational efficiency, and organizational effectiveness.
• Establish, monitor, and communicate operational KPIs, business metrics, and performance trends while driving accountability for measurable business outcomes.
• Utilize data and operational insights to proactively identify risks, workflow bottlenecks, and opportunities for continuous improvement.
• Balance operational priorities while ensuring timely, accurate, and compliant claim dispute resolution.
• Champion continuous improvement by identifying opportunities to redesign workflows, simplify processes, and eliminate operational inefficiencies.
• Drive adoption and optimization of AI-enabled workflows, automation technologies, and operational tools that improve productivity, quality, scalability, and associate effectiveness.
• Partner with Product teams to translate operational challenges into system enhancements, automation opportunities, and future product capabilities.
• Support implementation of new operational processes, technologies, and business initiatives while ensuring successful organizational adoption.
• Develop inventory management strategies utilizing forecasting, workload balancing, capacity planning, and workforce optimization techniques.
• Manage staffing levels, resource allocation, scheduling, and organizational structure to support changing business volumes and service expectations.
• Monitor inventory health, backlog performance, throughput, and cycle times while implementing corrective actions as necessary.
• Partner with leadership to develop flexible staffing models that support evolving operational demands.
• Ensure operational compliance with Federal Independent Dispute Resolution (IDR), the No Surprises Act (NSA), client-specific requirements, and internal operational standards.
• Monitor operational risks, workflow exceptions, audit findings, and regulatory changes while implementing sustainable corrective actions.
• Promote operational consistency through standardized procedures, quality controls, and governance practices.
• Maintain awareness of healthcare industry trends, regulatory updates, and operational best practices that impact Out of Network Post Pay operations.
• Build strong partnerships across key stakeholders to align priorities and improve business outcomes.
• Influence operational strategy by providing business insights, performance trends, and recommendations that support enterprise decision-making.
• Collaborate with stakeholders to improve workflow design, operational processes, reporting capabilities, and customer experience.
• Present operational performance, forecasts, risks, and improvement recommendations to leadership and business partners.
• Build and develop a high-performing team through coaching, performance management, career development, succession planning, and continuous feedback.
• Foster a culture of accountability, trust, innovation, collaboration, and responsible experimentation aligned with Zelis leadership expectations.
• Lead through change by communicating priorities clearly, building organizational alignment, and helping associates successfully adapt to evolving business needs.
• Establish clear performance expectations while recognizing achievements and proactively addressing performance concerns.
• Promote associate engagement, continuous learning, and professional growth while encouraging adoption of AI-enabled tools and new ways of working.

Skills

People leadership

Operational analytics

Stakeholder management

Change management

AI automation experience

BI / reporting tools

Process improvement

Communication skills

Problem solving

Education

Bachelor's degree in related discipline

Tools

Workflow management platforms

BI platforms / reporting

Job description

Zelis is hiring a Manager, Provider Dispute Resolution to lead Federal IDR and Out of Network Post Pay operations, ensuring quality, productivity, and compliance while driving AI-enabled improvements and workforce development.

You will partner with Product, Technology, and Client Management to enhance performance, scalability, and customer outcomes, building high-performing teams and a culture of accountability.