The posting
Summary The Manager, (Medical Bill) Advocacy & Dispute Resolution is accountable for the end-to-end design, operation, and performance of provider payment inquiry and disputes as well as the member balance bill Advocacy Program. This leader manages a team of Negotiators, Paralegals, and Member Bill Advocates whose mission is to protect members from unexpected out-of-network charges and to resolve provider payment inquiries and disputes. The Manager ensures the program operates in compliance with the organization’s sharing program guidelines, oversees delegated third-party vendor performance against contracted service levels — including Zelis Healthcare (or other contracted vendor) for delegated provider inquiry and dispute response — delivers measurable financial protection to plan members, and provides data-driven program insights to plan leadership. The role requires equal strength in people leadership, vendor management, regulatory knowledge, operational execution, and stakeholder communication. Essential Duties and Responsibilities Program Leadership & Strategy
Establish and continuously improve program policies, procedures, workflows, and quality standards for the full advocacy case lifecycle, including balance bill resolution, provider payment inquiries, and provider payment disputes Define program KPIs and success metrics in collaboration with plan leadership; lead quarterly business reviews and deliver monthly performance dashboards Develop and maintain a risk register for high-dollar, legally complex, or member-sensitive cases; present risk summary to VP quarterly Design and implement the staffing ramp strategy using the range model, activating additional FTEs when defined monthly case thresholds are sustained for 60+ days
People Leadership
Provide effective management of staffing levels, performance, coaching, and development of member advocates, paralegals, negotiators and other Advocacy Team support roles Conduct regular 1:1 meeting with team members to ensure coaching, performance feedback and conflict resolution is addressed timely Design and deliver onboarding and training programs in coordination with the Training Team to ensure effective knowledge transfer, cross-functional education, and delivered quality to members and providers Designate and support embedded triage team leads to maintain effective day-to-day supervision Case Oversight & Escalation Review all open cases weekly to ensure compliance with resolution timelines, documentation standards, and communication requirements Serve as primary escalation authority for cases involving legal action, active collections, media attention, member disputes, or regulatory inquiries Authorize negotiation settlement parameters above negotiation-defined thresholds and approve cases proceeding to alternative dispute resolution or external legal counsel
Provider Payment Inquiries & Disputes
Establish and maintain policies, procedures, and quality standards covering the full lifecycle of provider payment inquiries and disputes Define inquiry response-time and dispute resolution targets; align internal standards to vendor and contract standards to deliver consistent provider and member experiences Review aged or unresolved payment disputes regularly and serve as primary escalation point for high-dollar, multi-party, member sensitive, or precedent-setting disputes Track inquiry and dispute volume, resolution rates, average closure time, and root-cause categories; identify recurring patterns and route systemic issues to Claims, Network Management, or Provider Relations for upstream correction Authorize settlement parameters and policy exceptions for disputes that exceed standard delegated authority thresholds
Delegated Vendor Oversight
Oversee vendor performance against contracted service level agreements related to provider payment inquiry and dispute response; including response-time SLAs, dispute resolution timelines, and escalation-handling commitments Monitor vendor response-time performance, inquiry closure rate, and dispute aging through scheduled operational reviews and the contracted reporting cadence Serve as the organization’s primary internal escalation point for vendor-handled inquiries and disputes that require sharing-ministry-side decisioning, policy interpretation, or settlement authority above vendor’s delegated threshold Coordinate corrective-action plans with vendors when performance falls below contracted service levels; document remediation, track to closure, and verify return to compliance Conduct quarterly contract performance reviews with vendors; document SLA performance, surface vendor capacity or service-level concerns, and recommend renewal, renegotiation, or replacement actions to plan leadership and Vendor Management Maintain shared documentation between the internal advocacy team and vendor covering case-handoff criteria, escalation protocols, settlement authority limits, and reporting standards
Regulatory Compliance
Ensure advocacy program activities comply with the organization’s sharing program guidelines, applicable laws, and required plan documents and disclosures Coordinate with Compliance on internal and external audits, correction action plans, and any regulatory reporting Contribute to the exercise and expression of Christian Care Ministry’s beliefs
Stakeholder Relations & Reporting
Serve as the advocacy program’s primary liaison to Needs Processing, Network Management, Provider Relations, Member Services, Finance, Compliance and Legal departments Present program performance results — including delegated-vendor performance — to plan leadership, the board of directors, and employer or member-group sponsors on a quarterly basis Manage vendor relationships for third-party arbitration platforms, legal research subscriptions, coding review services, and the vendor healthcare delegation All other duties as assigned
Essential Skills & Abilities
Demonstrated skill and subject matter expertise of provider payment dispute resolution, member billing protections, and applicable state laws affecting member medical billing Proven ability to manage delegated third-party vendor performance against contract service levels, including SLA monitoring, correction-action management, and escalation handling Proficient with case/customer management systems (such as Salesforce Health Cloud) Proficient with Microsoft Office Suite (Word, Excel, Outlook, PowerPoint, Teams) Strong Analytics skill – able to create, manage, and easily read complex data reporting and translate it to meaningful insights Communication skill – able to effectively produce and communicate in written, digital, and oral formats messages that motivate others to action across wide audiences (including executive levels) Proven ability to manage cross-functional relationships in a regulated environment Knowledge of Zelis Healthcare standards and operations Familiarity with Hybrid Multi-Band or multi-tier provider network plan/program structures Familiarity with healthcare sharing operating models, member sharing guidelines, and shared-eligibility determinations
Core Competencies/Demonstrable Behaviors
Member First – exhibits full commitment to serving members and/or clients by prioritizing their needs first in alignment with our program’s purpose. This commitment is demonstrated through understanding of the program(s), provided through quality and timely service while exercising empathy in every interaction. Every CCM employee shares responsibility to steward resources faithfully, removing barriers to understanding, and creating accessible, connected, and Christ-centered experiences. Humble – demonstrates Christ-Centered humility by honoring others, accepting feedback, and prioritizing collective success over individual recognition Hungry – exhibits initiative, perseverance, and commitment to serving God through excellence. Demonstrates passion for personal and organizational growth while diligently advancing the mission of Christian Care Ministry Smart – shows relational and emotional intelligence, communicates effectively, collaborates harmoniously, and reads social cues with grace and discernment Leadership – ability to effectively lead cohesive, unified, high performing teams
Education and/or Experience
Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, or a closely related field; Masters’ degree in Healthcare Administration, Business Administration, or Juris Doctorate (JD) preferred Minimum 5 years of experience in health plan operations, healthcare sharing ministry operations, member services, provider relations, and/or managed care required; preference given to those with experience in balance billing advocacy, provider payment resolution, or third-party arbitration proceedings experience Minimum 2 years of direct people management or team lead experience required Direct experience managing or overseeing a Zelis Healthcare delegation or comparable payment-integrity/provider dispute vendor relationship required Certified Managed Care Professional (CMCP) or equivalent managed care certification preferred Experience managing a team in a contact center, appeals & grievance, or provider dispute environment preferred
Supervisory Responsibilities This job has supervisory responsibilities Travel This role may require occasional travel within the US 1-4 times per year
