Legal Manager

Job Summary

The Legal Manager is responsible for leading the day-to-day operations and performance of the Legal Negotiation team, including Legal Negotiators and Senior Legal Negotiators. This position provides direct people leadership, oversees negotiation and appeal workflows, monitors team performance and workload, and ensures matters are handled accurately, efficiently, and in accordance with applicable plan provisions, contractual requirements, internal procedures, and regulations.

The Legal Manager serves as an escalation point for complex, high-dollar, sensitive, and time-critical matters and partners closely with the Senior Director of Legal on operational priorities, risk identification, team development, and continuous improvement initiatives.

This is a working manager position, with approximately 60% of the role focused on people leadership and department management and approximately 40% focused on operational and case-related responsibilities. Depending on business needs and claim volume, the Legal Manager may maintain a limited caseload and directly manage complex negotiations and appeals.

Essential Job Responsibilities

Leadership & Team Management

• Provide direct leadership, supervision, coaching, and development to Legal Negotiators and Senior Legal Negotiators.
• Establish clear performance expectations and hold team members accountable for quality, productivity, responsiveness, documentation, and timely resolution of assigned matters.
• Conduct regular one-on-one meetings, team meetings, performance discussions, and formal performance evaluations.
• Provide ongoing coaching and feedback related to negotiation strategy, communication, documentation, time management, judgment, and professional development.
• Identify individual and team development needs and coordinate appropriate training, cross-training, mentoring, and development opportunities.
• Partner with Human Resources and Legal leadership regarding recruiting, interviewing, selection, onboarding, performance management, corrective action, and other employee-related matters.
• Review and approve employee schedules, time-off requests, and other workforce needs in accordance with Company policies and business requirements.
• Promote a collaborative, accountable, solutions-oriented team environment.
• Support succession planning and employee development by identifying high-potential team members and opportunities for increased responsibility.

Department Operations & Workload Management

• Oversee the daily workflow of the Legal Negotiation team to ensure claims, negotiations, appeals, and escalated matters are assigned and resolved appropriately.
• Monitor team caseloads, aging matters, deadlines, high-risk files, and other workload indicators and redistribute work as necessary.
• Establish priorities based on client needs, claim complexity, financial exposure, regulatory requirements, deadlines, and business risk.
• Ensure adequate staffing and coverage to support departmental service levels and business needs.
• Monitor adherence to established workflows, documentation standards, escalation procedures, and departmental expectations.
• Identify workflow bottlenecks, capacity concerns, recurring issues, and operational risks and implement or recommend appropriate solutions.
• Partner with the Senior Director of Legal to establish and monitor departmental goals, priorities, service standards, and performance expectations.
• Assist with workforce planning and resource allocation based on claim volume, complexity, business growth, and departmental needs.

Complex Negotiations & Appeals

• Provide guidance and strategic direction to team members regarding complex, high-dollar, sensitive, or escalated negotiations and appeals.
• Review claim information, supporting documentation, system data, plan provisions, and relevant circumstances to evaluate negotiation strategies and potential resolution options.
• Review and provide guidance regarding settlement strategies and recommended settlement ranges for matters requiring management involvement.
• Serve as an escalation point when negotiations become complex, sensitive, time-critical, or present increased financial, client, or legal risk.
• Participate in or lead resolution calls with clients, providers, third-party collection entities, and other stakeholders when management involvement is appropriate.
• Maintain a limited caseload when business needs, staffing levels, or claim volume require additional management support.
• Prepare, negotiate, document, and resolve assigned matters in accordance with established procedures and applicable requirements.
• Escalate matters to the Senior Director of Legal or counsel when additional legal review, authority, or strategic direction is appropriate.

Quality, Risk Mitigation & Compliance

• Ensure negotiation strategies, appeal handling, documentation, and resolutions are consistent with applicable plan provisions, contractual obligations, internal procedures, and applicable laws and regulations.
• Monitor the quality and consistency of team documentation, negotiation practices, settlement decisions, and escalation procedures.
• Conduct periodic case and documentation reviews to identify coaching opportunities, quality concerns, process gaps, and potential risks.
• Identify recurring dispute drivers, operational concerns, emerging trends, or potential areas of legal or financial exposure and escalate findings to the Senior Director of Legal.
• Support root-cause analysis and corrective action initiatives intended to reduce recurring disputes and improve negotiation outcomes.
• Promote appropriate handling and protection of confidential, sensitive, and proprietary information.
• Support team understanding and application of ERISA, ACA, the No Surprises Act, and other requirements applicable to the team's negotiation and appeal responsibilities.

Reporting & Performance Management

• Monitor departmental performance indicators, including caseload volume, aging matters, resolution timelines, settlement activity, escalations, productivity, and other established metrics.
• Use departmental data to identify performance trends, workload concerns, process opportunities, and areas requiring management attention.
• Provide regular status updates and reporting to the Senior Director of Legal regarding team performance, significant matters, operational risks, staffing needs, and departmental priorities.
• Establish appropriate action plans when performance, quality, productivity, or service levels do not meet expectations.
• Maintain visibility into high-dollar, high-complexity, time-sensitive, and at-risk matters and ensure appropriate follow-up through resolution.

Process Improvement & Department Development

• Lead and support continuous improvement initiatives designed to increase efficiency, consistency, quality, and effectiveness within Legal Negotiation operations.
• Develop, implement, and maintain negotiation playbooks, procedures, templates, decision trees, escalation guidance, checklists, and other departmental resources.
• Evaluate existing workflows and recommend process or system improvements that support better outcomes and employee productivity.
• Ensure lessons learned from complex negotiations, appeals, escalations, and recurring disputes are incorporated into team training and departmental guidance.
• Partner with the Senior Director of Legal on departmental initiatives, special projects, and implementation of new processes or requirements.
• Support change management by communicating expectations, providing training, monitoring adoption, and reinforcing new processes.

Cross-Functional Collaboration

• Collaborate with Legal, Operations, Advocacy, Client Services, and other internal teams to resolve issues, improve workflows, and support positive client outcomes.
• Serve as a primary point of contact for operational matters involving the Legal Negotiation team.
• Communicate professionally and effectively with internal and external stakeholders regarding escalated matters, resolution strategies, timelines, and departmental priorities.
• Partner with other leaders to identify and resolve cross-functional issues affecting claims, negotiations, appeals, or client service.
• Represent the Legal Negotiation team in meetings, projects, and cross-functional initiatives as appropriate.

Skills & Abilities

• Strong people leadership, coaching, and performance management skills
• Advanced negotiation, problem-solving, and conflict-resolution skills
• Demonstrated ability to lead and develop high-performing teams
• Strong judgment and ability to make sound decisions involving complex or sensitive matters
• Ability to manage competing priorities, deadlines, workloads, and escalations in a high-volume environment
• Strong analytical skills and ability to interpret complex claim information and plan language
• Excellent written and verbal communication skills
• Strong interpersonal skills and ability to communicate effectively with employees at all organizational levels and external stakeholders
• Ability to identify trends, assess risk, and develop practical solutions
• Strong organizational skills and attention to detail
• Ability to effectively delegate while maintaining appropriate accountability and oversight
• Ability to manage change and drive process improvement
• Proficiency with claim documentation and workflow systems
• Ability to use data and performance metrics to manage departmental operations and employee performance
• Demonstrated discretion and ability to handle confidential and sensitive information
• Ability to work independently while effectively leading a collaborative, team-based environment
• Ability to pass a background check in accordance with applicable laws

Education & Experience

• Bachelor's degree required.
• Minimum of five (5) years of progressively responsible experience in legal, paralegal, claims, healthcare, negotiation, or a related field required; seven (7) or more years preferred.
• Prior supervisory, management, or demonstrated team leadership experience strongly preferred.
• Demonstrated experience coaching, developing, and providing performance feedback to employees required.
• Significant experience with settlement negotiations, claims resolution, appeals, or complex dispute resolution strongly preferred.
• Experience managing complex, high-dollar, sensitive, or escalated matters preferred.
• Experience applying ERISA and ACA requirements in claim reviews, appeals management, and settlement negotiations preferred.
• Experience or working knowledge of the No Surprises Act, including its application to negotiation and IDR process requirements, preferred.
• Experience monitoring operational metrics, workloads, deadlines, and team performance preferred.
• Experience developing or implementing procedures, workflows, training materials, or process improvements preferred.

Physical Requirements & Work Environment

• Fully remote position with the expectation of in-office attendance for meetings, training, or collaboration sessions as needed. Employees must be able to travel to the designated office location with reasonable notice.
• Intermittent physical effort may include lifting up to 25 pounds, walking, standing, kneeling, crouching, or crawling.
• Frequent sitting, keyboard use, reaching, talking, and hearing for approximately 70% of the workday; standing approximately 30% or less.
• Normal vision abilities required, including close vision and the ability to adjust focus.

Equal Employment Opportunity

Advanced Medical Pricing Solutions (AMPS) provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.