Zelis · 5 hours ago
Director, NSA IDR & State Compliance Operations
New Jersey, United States
Full-time
Onsite
Lead/Staff, Director/Executive
$169K/yr - $214K/yr
12+ years expZelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. The Director of Compliance Operations is responsible for overseeing all operational, regulatory, and strategic aspects of No Surprises Act related to Independent Dispute Resolution and State Arbitration programs, ensuring compliance and efficiency across federal and state requirements.
FinanceFinTechHealth Care
No H1B
Responsibilities
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
Qualification
Required
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
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
Preferred
Experience with payers, TPAs, providers, regulators, or dispute resolution entities
Background in arbitration case management or financial modeling
Experience with regulatory workflow technology or automation platforms
Benefits
401k plan with employer match
Flexible paid time off
Holidays
Parental leaves
Life and disability insurance
Health benefits including medical, dental, vision, and prescription drug coverage
Company
Zelis
Zelis is modernizing the healthcare financial experience for all.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
$20.15MKey Investors
Mubadala
2024-12-04Private Equity
2020-01-05Private Equity· $20.15M
2019-01-01Private Equity
Leadership Team
Amanda Eisel
Chief Executive Officer
Brian Gladden
Chief Financial Officer
Recent News
2026-01-15
2025-12-10
Company data provided by crunchbase