Quality and Compliance Senior Manager in a global accounting firm, leading risk governance and quality assurance projects for successful advisory engagements.
About the role
- 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.
- Proven leadership experience managing large, multi-site (onshore and offshore) operational teams.
- 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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