Manager - Arbitration Operations

Essential Duties and Responsibilities:

- Manage assigned teams and staff.

- Develop, monitor, and use quality control procedures and audit criteria to ensure consistent application of contractual requirements and established policies and procedures.

- Frequent interaction with subordinate employees, customers, and/or functional peer group managers, normally involving matters between functional areas, other company divisions or units, or customers and the company.

- Provide guidance to subordinates within the latitude of established company policies.

- Recommend changes to policies and establish procedures that affect immediate organization(s).

- Perform other duties as assigned by management.

- Ability to perform comfortably in a fast-paced, deadline-orientated work environment.

- Excellent organizational, interpersonal, written, and communication skills.

- Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.

- Develop and analyze operational reports, dashboards, and key performance indicators.

- Monitor program performance against contractual SLAs and performance guarantees.

- Perform other duties as assigned by management.

Operational Leadership:
- Manage daily operations of the surprise billing arbitration program, ensuring timely and accurate case processing.
- Lead, coach, and develop a team of supervisors, analysts, coordinators, and arbitration specialists.
- Monitor workloads, staffing levels, productivity, and quality performance metrics.
- Establish and implement operational procedures, workflows, and best practices.
- Identify process improvement opportunities and implement solutions to increase efficiency and compliance.

Program Administration:
- Oversee intake, review, assignment, tracking, and resolution of arbitration cases.
- Manage assigned staff.
- Provide guidance to subordinates within the latitude of established company policies.
- Recommend changes to policies and establish procedures that affect immediate organization(s).
- Ensure cases are managed in accordance with applicable state laws, regulations, policies, and contractual requirements.
- Maintain comprehensive documentation and case management protocols.
- Coordinate with arbitrators, providers, health plans, and regulatory agencies throughout the dispute resolution process.

Compliance & Quality Assurance:
- Ensure adherence to state surprise billing regulations, privacy requirements, and program standards.
- Monitor quality assurance activities and implement corrective action plans when needed.
- Conduct audits and reviews to ensure consistency and accuracy in program administration.
- Support regulatory reporting and compliance monitoring activities.

Client & Stakeholder Management:
- Serve as a primary operational contact for state agency representatives and key stakeholders.
- Facilitate meetings, program reviews, and performance discussions.
- Resolve escalated issues and stakeholder concerns in a timely ...