Regulatory Process Manager (IDRE)

About the role

We are looking for a Regulatory Process Manager — PRI LLC's subject matter expert and go-to investigator for complex issues within the No Surprises Act IDR process. This is a senior individual contributor role that sits at the intersection of regulatory expertise, case investigation, and process improvement.

Responsibilities

• Interpret NSA rules, CMS guidance, and PRI LLC procedures in real time without escalating routine questions upward
• Investigate complex exceptions in our case files — identify root causes, report patterns, recommend process improvements
• Conduct audilevel case file reviews in GlideOps to answer stakeholder questions with specificity and documentation
• Track CMS guidance and interim final rules; communicate relevant changes to internal stakeholders proactively
• Manage escalated disputes through to resolution, coordinating with QA, compliance, and operations
• Support the CCO and VP Compliance on CMS and URAC audits and regulatory correspondence
• Collaborate with L&D and Compliance on developing training content for complex IDR process areas
• Represent PRI LLC at external meetings, webinars, and educational events as a subject matter authority

Requirements

JD or LLM preferred; significant NSA/IDRE operational, regulatory, or arbitration experience considered in lieu

Arbitration experience — IDR arbitration ideal; AAA, JAMS, AHLA, or commercial arbitration background considered

Deep familiarity with the No Surprises Act IDR process — you know it well enough to catch errors and explain edge cases

Auditor instinct: when something is complex, you move toward it, not away from it

Experience identifying patterns across large case volumes and translating them into process improvements

Ability to make decisions independently and move fast without committee input on regulatory questions

Prior IDRE, IRO, managed care, utilization review, or healthcare regulatory environment experience

Qualifications

Not specified

Skills

Not specified

Benefits

Not specified

Pay

Not specified

Schedule

Not specified

Equal Opportunity Employer

PRI LLC is an equal opportunity employer. We evaluate candidates on demonstrated skills and capability.