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