Provider Escalation and Education Senior Manager

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Provider Escalation and Education Senior Manager based in the United States. As a Provider Escalation and Education Senior Manager, you will lead the resolution of complex healthcare claims disputes while strengthening payment accuracy, regulatory compliance, and provider relationships. Acting as the highest escalation point for challenging claims issues, you will apply your expertise in Medicare regulations, medical coding, and reimbursement policies to deliver accurate and defensible decisions. You will investigate recurring operational problems, identify their root causes, and collaborate with technical and operational teams to implement sustainable improvements. Working across Claims, Configuration, Payment Integrity, and Engineering, you will help streamline processes through automation and AI-enabled solutions. You will also play a key role in developing training programs and operational guidance for external vendors and distributed teams. This position combines deep technical expertise, analytical problem-solving, and hands-on leadership in a fast-paced healthcare environment. Your contributions will directly improve claims operations, reduce provider friction, and support better regulatory and operational outcomes.