Director, NSA IDR & State Compliance Operations

Position Overview

What you'll do:

• 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.

• Represent the organization in client governance, regulatory discussions, and strategic business reviews.

What you'll bring to Zelis:

• 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.

• Skilled at translating regulatory complexity into operational execution.

• Collaborative leader who influences across teams and organizations.

• High integrity, compliance orientation, and commitment to quality.

Base Salary Range

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.

Zelis' full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees' health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.