Risk Product Manager

Overview

Title:

Risk Manager

Location:

Remote

Duration: 6 month CTH

Job Summary

We are seeking a strategic, analytical Risk Manager to oversee and optimize provider network performance with a strong emphasis on dispute avoidance, dispute resolution, and risk mitigation within the workers’ compensation bill review process.

In this role, you will act as the central point of accountability for provider reimbursement disputes, ensuring network partners operate in alignment with contractual, regulatory, and operational expectations. You will collaborate closely with internal stakeholders, provider networks, and clients to reduce dispute volume, improve resolution outcomes, and protect financial and reputational risk while maintaining high service quality.

• Dispute Prevention & Resolution:
  Develop and enforce network policies and workflows to provider reimbursement disputes related to PPO discounts, provider contracts, and post-bill review reductions.
• Dispute Prevention & Resolution:
  Analyze provider appeals and adjustments to identify trends and root causes, recommending data-driven improvements.
• Dispute Prevention & Resolution:
  Collaborate with legal, clinical, and compliance teams to resolve provider disputes efficiently and consistently.
• Dispute Prevention & Resolution:
  Promote proactive communication with providers to enhance understanding of reimbursement processes and reduce conflict.
• Performance Measurement & Optimization:
  Design and maintain network performance dashboards tracking metrics.
• Performance Measurement & Optimization:
  Collaborate with analytics teams to evaluate network quality, effectiveness, and impact on claims outcomes.
• Product Development & Enhancement:
  Own the lifecycle of network-related solutions that enhance compliance, savings, and stakeholder satisfaction.
• Product Development & Enhancement:
  Translate client requirements and regulatory changes into actionable product improvements.
• Product Development & Enhancement:
  Monitor market and regulatory trends to guide product innovation and maintain competitive advantage.
• Cross-Functional Leadership &
  
  Collaboration:
  
  Serve as the subject matter expert on network products, provider performance, and dispute processes.
• Cross-Functional Leadership &
  
  Collaboration:
  
  Partner with internal teams—including sales, account management, RFPs, and product launches.
• Cross-Functional Leadership &
  
  Collaboration:
  
  Collaborate with external vendors and partners.

• 7-10 years of experience in Network Management and/or Group Health
• Experience working in or with Bill Review disciplines
• Strong written and verbal communications
• Experience working in a matrixed organization and effective with multi-stakeholder management
• Excellent relationship management and issue resolution skills
• Enjoys managing talent at all levels; familiarity working with offshore teams a plus
• Proven experience in vendor management
• Excellent organizational, analytical, and communication skills.

The work environment characteristics described here is representative of those of a standard office setting. The noise level in the work environment is usually moderate.

While performing the duties of this job, the employee must be able to remain in a stationary position over 50% of the work day; move about inside the office to access files or office equipment; use hands to finger, handle, or feel objects, tools, or controls to operate a computer and other office productivity machines; reach with hands and arms; must communicate and converse with co-workers;

and detect/discern information accurately. Specific vision abilities required by this job include close vision and the ability to adjust focus. The employee must occasionally lift and/or move up to 10 pounds.

• Possibility for remote and hybrid work opportunities
• Great work-life balance
• Medical, Dental and Vision insurance
• Company paid Life & Disability Insurance
• Flexible Spending Accounts
• 401(k) with employer contribution
• Generous Paid Time-Off policies
• Employee Assistance Program
• Referral Program

Disclaimer

The aforementioned statements are intended to describe the general nature and level of work to be performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of an incumbent.

Equal Opportunity Employer:
Medasource is an equal opportunity employer that does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, lactation and related medical conditions), gender identity or gender expression, sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances.

About Medasource

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