Director of Compliance Operations overseeing compliance for NSA and IDR programs at Zelis. Leading strategic and regulatory oversight across multi-layered teams and ensuring operational efficiency.
Responsibilities
Oversee end-to-end compliance operations for NSA related IDR, and State Arbitration, ensuring adherence to all federal and state requirements.
Monitor CMS rulemaking and state-level updates to proactively adjust operational processes and internal controls.
Partner with Legal, Compliance, and Product teams to interpret regulations and translate them into scalable workflows and documentation.
Ensure audit-readiness, risk mitigation, accurate reporting, and regulatory transparency.
Develop and execute a comprehensive strategy that aligns operational performance, compliance requirements, and downstream financial impact.
Analyze and translate operational performance (win rates, processing times, arbitration outcomes, submission quality, error rates) into clear financial outcomes, including revenue impact, cost implications, and profitability.
Provide forward-looking financial insights and modeling based on operational trends, regulatory changes, and volume shifts.
Lead day-to-day operations across high-volume compliance workflows, optimizing for efficiency, accuracy, and financial outcomes.
Identify automation opportunities, technology enhancements, and process redesign to improve quality and reduce cost.
Implement KPIs, SLAs, dashboards, and operational scorecards that tie performance outcomes directly to financial results.
Oversee budgeting, forecasting, staffing models, and capacity planning across onshore and global teams.
Direct, mentor, and develop a diverse workforce spanning domestic and global operations.
Ensure teams are trained and equipped to meet evolving regulatory and operational standards.
Drive a culture of accountability, performance excellence, and continuous improvement.
Serve as a senior-level point of contact for clients, regulatory partners, arbitrators, and third-party vendors.
Build strong partnerships to align on expectations, performance outcomes, compliance obligations, and financial impacts.
Oversee vendor contracts, performance monitoring, compliance standards, and escalation processes.
Requirements
Bachelor’s degree in Business, Health Administration, Compliance, or related field; advanced degree preferred.
12+ years of experience in healthcare operations, regulatory compliance, managed care, claims, or arbitration programs.
Deep expertise in the No Surprises Act, Federal IDR, and State Arbitration regulations and workflows.
Demonstrated ability to connect operational performance to financial outcomes, including interpreting data, forecasting, and presenting findings to executives.
Strong analytical, strategic thinking, and problem-solving abilities.
Exceptional communication skills with experience engaging executive-level clients and partners.
Experience with payers, TPAs, providers, regulators, or dispute resolution entities preferred.
Background in arbitration case management or financial modeling preferred.
Experience with regulatory workflow technology or automation platforms preferred.
Strategic and financially minded operator with the ability to bridge compliance, analytics, and performance management.
High integrity, compliance orientation, and commitment to quality.
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
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