Pegasus Knowledge Solutions, Inc. · 21 hours ago
Risk Manager
United States
Full-time
Remote
Senior Level
7+ years expPegasus Knowledge Solutions, Inc. is seeking a strategic, analytical Risk Manager to oversee and optimize provider network performance with a strong emphasis on dispute avoidance, resolution, and risk mitigation. In this role, you will act as the central point of accountability for provider reimbursement disputes and collaborate closely with internal stakeholders, provider networks, and clients to protect financial and reputational risk while maintaining high service quality.
Information Technology
Hiring Manager
Anam Chaudhry
Responsibilities
Develop and enforce network policies and workflows to provider reimbursement disputes related to PPO discounts, provider contracts, and post-bill review reductions
Analyze provider appeals and adjustments to identify trends and root causes, recommending data-driven improvements
Collaborate with legal, clinical, and compliance teams to resolve provider disputes efficiently and consistently
Promote proactive communication with providers to enhance understanding of reimbursement processes and reduce conflict
Design and maintain network performance dashboards tracking metrics
Collaborate with analytics teams to evaluate network quality, effectiveness, and impact on claims outcomes
Own the lifecycle of network-related solutions that enhance compliance, savings, and stakeholder satisfaction
Translate client requirements and regulatory changes into actionable product improvements
Monitor market and regulatory trends to guide product innovation and maintain competitive advantage
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
Qualification
Required
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
Company
Pegasus Knowledge Solutions, Inc.
Founded in 1997, PKSI [Pegasus Knowledge Solutions, Inc.] is an independent, advanced analytics software and services organization, that partners with the industry leading providers to help customers create value from their data, bringing a range of talents, including data integration and preparation, big data environments, data mining, predictive analytics, machine learning and text mining, as well as dashboarding and visualization.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Lawrence Hall
Director of AI Solutions and Partnerships
Company data provided by crunchbase