Risk Manager- Provider Network

We are seeking a strategic and analytical Risk Manager to oversee provider network performance, with a focus on dispute prevention, resolution, and risk mitigation within the workers’ compensation bill review process. This role will serve as the central point for managing provider reimbursement disputes and ensuring alignment with contractual and regulatory standards.

Key Skills:

• 7–10 years of experience in Network Management or Group Health
• Experience with bill review processes
• Strong communication and stakeholder management skills
• Vendor management experience
• Analytical mindset with excellent problem-solving abilities
• Experience working in matrixed organizations; offshore team exposure is a plus

Key Responsibilities:

• Lead dispute prevention and resolution related to provider reimbursements
• Analyze trends, identify root causes, and drive process improvements
• Collaborate with legal, clinical, compliance, and external partners
• Monitor and optimize network performance using data and dashboards
• Support product enhancements and ensure regulatory compliance
• Act as SME for network operations and provider performance

If you are interested, please share your updated resume at sjain@pksi.com