Senior Managing Director, Healthcare Disputes & Economics, Payer/Provider

Practice Overview: 

Ankura’s Health Care team is a recognized leader in health care and life sciences disputes, compliance, and investigations. The team combines clinical, technical, operational, financial, economic, and analytic expertise to help clients and counsel resolve complex matters involving payers, providers, pharmacies, and law firms.

This role is specifically focused on expanding Ankura’s payer/provider disputes platform: matters where commercial, Medicare Advantage, Medicaid managed care, exchange, and other health plan arrangements require rigorous data analytics and defensible damages analysis.

Role Overview: 

The Senior Managing Director will be an executive-level, self-sustaining rainmaker who originates, sells, leads, and testifies in complex healthcare commercial disputes. The role requires a credible marketplace presence with health plans, law firms, and healthcare-focused private equity or strategic stakeholders.

• Primary focus: payer/provider contract, payment, reimbursement, claims, coding, utilization, medical policy, network, and financial disputes.

• Core technical differentiator: ability to direct large-scale data analytics teams and translate complex healthcare datasets into clear, supportable damages opinions.

• Expected revenue impact: proven, tangible business development record with the ability to produce at least $3M in revenue and a target opportunity to generate $3M to $5M+ annually.

• Expert role: serve as a consulting expert or testifying expert, including report development, deposition preparation, arbitration or trial testimony, and expert rebuttal work.

Target Candidate Profile:

• Market position: Recognized rainmaker in healthcare disputes with established relationships among payer/provider counsel, managed care executives, provider finance leaders, and litigation decision-makers.

• Dispute focus: Deep experience in payer/provider commercial disputes, including underpayment, overpayment, contract interpretation, rate methodology, coding, claim adjudication, stop-loss, risk adjustment, value-based care, network adequacy, medical necessity, utilization, denial, recoupment, and reimbursement disputes.

• Data analytics leadership: Can lead multidisciplinary teams analyzing large claims, eligibility, encounter, remittance, contract, provider, authorization, utilization, coding, clinical, and financial datasets using scalable, quality-controlled analytics.

• Damages expertise: Can develop defensible models for lost revenue, underpayment, overpayment, offsets, recoupments, interest, damages scenarios, counterfactuals, and sensitivity analyses.

• Expert witness credibility: Has authored expert reports and provided deposition, arbitration, trial, or hearing testimony in healthcare disputes.

Responsibilities: 

Business Development and Market Leadership

• Originate and expand relationships with national and regional law firms, health plans, pharmacy organizations, and healthcare investors that routinely face payer/provider reimbursement and damages disputes.

• Develop a go-to-market plan focused on payer/provider disputes where Ankura can combine healthcare industry expertise, advanced analytics, damages modeling, and expert testimony.

• Build a visible marketplace presence through panels, publications, law firm briefings, client training, and industry events focused on managed care litigation, reimbursement disputes, and claims analytics.

• Convert marketplace relationships into consulting expert, testifying expert, privileged advisory, and complex analytics engagements.

Technical and Disputes Expertise

• Lead matters involving contract breaches, payment disputes, underpayment or overpayment claims, reimbursement methodology, fee schedules, DRG/APC/APG or other payment logic, risk corridors, value-based payment, capitation, shared savings, risk adjustment, denials, recoupments, and claims adjudication issues.

• Apply knowledge of commercial, Medicare Advantage, Part D, Medicaid managed care, ACA exchange, pharmacy, and provider reimbursement operations when developing case strategy and damages approaches.

• Assess liability and damages theories in collaboration with counsel while preserving attorney-client privilege, work-product protection, and expert independence where applicable.

• Prepare expert reports, rebuttal reports, declarations, deposition testimony, arbitration testimony, trial testimony, and demonstratives that explain complex analytics in plain English.

Large-Scale Data Analytics and Damages

• Direct data teams analyzing high-volume healthcare datasets, including claims, encounters, eligibility, premium, membership, remittance, EOB/EOP, authorization, denial, utilization, coding, provider contract, fee schedule, capitation, risk adjustment, and financial data.

• Design repeatable analytic workplans that include data intake, normalization, validation, completeness testing, reconciliation, exception handling, sampling or extrapolation where appropriate, quality control, and audit trails.

• Develop damages models that quantify alleged underpayments, overpayments, lost revenue, leakage, offsets, recoupment exposure, reasonable value, contract-based damages, and alternative damages scenarios.

• Translate analytic findings into counsel-ready narratives, executive presentations, settlement support, mediation materials, expert reports, and trial or arbitration demonstratives.

• Partner with data scientists, statisticians, coding experts, clinicians, economists, forensic accountants, and operations professionals to ensure analytic conclusions are technically sound and legally defensible.

Client Delivery and Team Leadership

• Serve as the accountable executive on complex, multi-workstream matters with law firm, payer, provider, and board-level stakeholders.

• Scope and price engagements, staff teams, manage budgets, review work product, ensure quality, and deliver concise insights under litigation deadlines.

• Mentor directors, managing directors, analytics professionals, clinicians, coders, and operational specialists, with a focus on developing future testifying experts and client-facing leaders.

• Collaborate across Ankura practices, including Health Economics, Data Analytics including AI, Strategy and Performance, Forensic Accounting, Investigations, and other dispute capabilities.

Relevant Matter Experience

• Payer/provider contract disputes involving alleged underpayment, denial, repricing, reimbursement methodology, rate implementation, or recoupment issues.

• Managed care disputes involving Medicare Advantage, Medicaid managed care, ACA exchange, commercial group, self-funded, pharmacy, or delegated-risk arrangements.

• Large-scale claims and encounter analytics supporting affirmative damages, rebuttal damages, settlement valuation, mediation, arbitration, or trial.

• Hospital, physician, ancillary, pharmacy, behavioral health, and specialty provider reimbursement disputes.

• Matters requiring expert reports, rebuttal analyses, deposition testimony, arbitration testimony, or trial testimony.

Qualifications:  

• Bachelor’s degree from an accredited university in business, finance, accounting, economics, data analytics, health care operations, health policy, clinical discipline, or a related field; advanced degree preferred.

• 10+ years of litigation, disputes, forensic, damages, payer/provider reimbursement, managed care, healthcare analytics, or consulting experience; senior consulting leadership experience strongly preferred.

• Proven and tangible business development record with a portable book of relationships and revenue generation of at least $3M; demonstrated ability to grow toward $3M to $5M+ annually.

• Specific experience originating and leading payer/provider commercial disputes, reimbursement disputes, managed care litigation, claims analytics, damages quantification, or expert witness engagements.

• Demonstrated ability to direct large project teams analyzing complex healthcare datasets and producing quality-controlled analytic outputs for counsel, executives, and triers of fact.

• Experience authoring expert reports, rebuttal reports, declarations, affidavits, or damages analyses; prior deposition, arbitration, trial, or hearing testimony strongly preferred.

• Strong understanding of healthcare legal, regulatory, reimbursement, and operational issues affecting payers, providers, pharmacies, and government program participants.

• Exceptional executive communication skills, including the ability to explain complex technical, analytic, reimbursement, and damages issues to boards, C-suite clients, law firms, regulators, mediators, arbitrators, judges, and juries.

• Demonstrated commitment to privilege, confidentiality, work-product discipline, expert independence, collaboration, quality, and team development.

• Ability and willingness to travel; must be legally authorized to work in the United States without employer sponsorship now or in the future.