Director, NSA IDR & State Compliance Operations

Overview

At Zelis, we Get Stuff Done. So, let’s get to it!

Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you ve learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you ve gained, and the personal interests that shape who you are.

The Director of Compliance Operations is a key enterprise leader responsible for overseeing all operational, regulatory, and strategic aspects of No Surprises Act (NSA) related to, Independent Dispute Resolution (IDR), and State Arbitration programs. This role ensures the organization consistently delivers compliant, efficient, and high-quality outcomes across all applicable federal and state regulatory requirements.

The Director will provide vision and leadership across a multi-layered team—including both US and global operations—and serves as the primary operational liaison for clients, regulators, and external vendor partners. Success in this role requires deep compliance expertise, advanced operational strategy, financial acumen, and an ability to navigate fast-evolving regulatory environments.

• Oversee end-to-end compliance operations for NSA related IDR, and State Arbitration, ensuring adherence to all federal and state requirements.
• Monitor CMS rule making 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.
• Represent the organization in client governance, regulatory discussions, and strategic business reviews.

• Bachelor’s degree in Business, Health Administration, Compliance, or related field; advanced degree preferred.
• 12+ years of experience in healthcare operations, regulatory…