Hybrid Network Risk Manager

at MedRisk

• Job title: Network Risk Manager
• Job type: Full Time
• Experience level: Senior, Lead
• Salary: $1 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Canada

About the role

• Risk Manager overseeing and optimizing provider network performance with emphasis on dispute resolution in workers' compensation. Collaborating with internal and external stakeholders to improve outcomes.

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

Requirements

• 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.

Benefits

• Possibility for remote and hybrid work opportunities
• Great work-life balance
• Medical, Dental and Vision insurance
• Company paid Life & Disability Insurance
• Flexible Spending Accounts
• 401(k) with employer contribution
• Generous Paid Time-Off policies
• Employee Assistance Program
• Referral Program