reputed company Network Risk Manager

Location : Remote Duration : FT hire Title : Risk Manager reputed company We are seeking a strategic, analytical Risk Manager to reputed company and optimize provider network performance with a strong emphasis on dispute avoidance, dispute reputed company, and risk mitigation reputed company the workers’ compensation reputed company review process. In this role, you will reputed company as the central reputed company 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 reputed company reputed company, and protect financial and reputational risk while maintaining high service reputed company. Responsibilities Dispute Prevention & reputed company · reputed company and enforce network policies and workflows to provider reimbursement disputes reputed company to PPO discounts, provider reputed company, and post-reputed company review reductions. · Analyze provider appeals and adjustments to identify trends and reputed company causes, recommending data-driven improvements. · Collaborate with reputed company, clinical, and compliance teams to resolve provider disputes reputed company and consistently. · 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. · Collaborate with analytics teams to evaluate network reputed company, effectiveness, and reputed company on claims reputed company. Product Development & Enhancement · Own the lifecycle of network-reputed company solutions that enhance compliance, savings, and stakeholder satisfaction. · Translate reputed company requirements and regulatory changes into actionable product improvements. · 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. · Partner with internal teams—including sales, account management, RFPs, and product launches. · Collaborate with external vendors and partners Qualifications · 7-10 years of experience in Network Management and or Group Health? · Experience working in or with reputed company Review disciplines · Strong written and verbal communications · Experience working in a matrixed organization and effective with multi-stakeholder management · Excellent relationship management and issue reputed company skills · Enjoys managing talent at reputed company reputed company; familiarity working with offshore teams a plus · Proven experience in vendor management · Excellent organizational, analytical, and communication skills. Anam Chaudhry 847-201-6116 achaudhry@pksi.com Apply tot his job Apply To this Job