Senior Manager, NSA Claims Settlement

Role Overview

• Sets direction and oversees Open Negotiations operational workflows and processes, ensuring timely, compliant, and high-quality delivery aligned with client and organizational objectives.
• Design, implement, and maintain policies and procedures for Open Negotiations operations; ensure consistent execution and adherence across teams.
• Serve as a subject matter expert (SME) for NSA regulations and processes, providing guidance to clients and internal stakeholders to ensure compliance.
• Lead and mentor team members through training, coaching, development, and performance management; must establish clear development objectives and accountability while fostering a collaborative team culture
• Establish, monitor, and report on key performance indicators (KPIs), ensuring quality assurance programs are in place to support operational excellence.
• Collaborate cross-functionally with internal partners including but not limited to Claims Management teams, Intake, IDR, and Client management to escalate, troubleshoot, and resolve operational, client, and system-related issues efficiently.
• Identify process improvement opportunities and partner with Product Owners and stakeholders to enhance technology solutions supporting NSA claims.
• Manage daily operations by monitoring system performance, resolving issues, implementing corrective action plans, and maintaining quality standards.
• Resolve escalated inquiries from providers, clients, and internal teams, ensuring timely and effective outcomes.
• Leads functional operating plans for Open Negotiations, including capacity models, staffing strategies, workforce planning, resourcing recommendations and productivity assumptions aligned to NSA volume forecasts in partnership with senior leadership.
• Prepare and deliver operational reports, performance insights, and strategic recommendations for clients and executive leadership.
• Assess regulatory changes and business growth scenarios to proactively adjust operating models and team structures.
• Lead and participate in cross-functional projects and initiatives as assigned.

Requirements

• 8+ years of progressive experience in healthcare claims and/or operations, or regulatory programs.
• 3+ years of leadership experience with demonstrated success leading teams in a production-driven environment with strict turnaround time and quality standards
• Experience with state and federal claim arbitration processes and regulatory compliance preferred.
• Proven ability to motivate, empower, and develop high-performing teams in a fast-paced, deadline-driven environment.
• Strong project management skills with the ability to manage multiple priorities and complex initiatives simultaneously.
• Exceptional leadership, interpersonal, organizational, and time management skills, with strong attention to detail.
• Excellent written and verbal communication skills, with the ability to engage effectively with internal teams, clients, providers, and senior leadership.
• Proficiency in Microsoft Office applications, particularly Word and Excel.
• Ability to work independently with minimal supervision while taking direction and delivering results on time.
• Experience leveraging specialized systems and software to improve operational efficiency.

Benefits

• 401k plan with employer match
• flexible paid time off
• holidays
• parental leaves
• life and disability insurance
• health benefits including medical, dental, vision, and prescription drug coverage