Claim Settlement Specialist
Claim Settlement Specialist
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Job Description
At Zelis we Get Stuff Done. So lets get to it!
A Little About Us
Zelis is modernizing the healthcare financial experience for all by providing a connected platform that bridges the gaps and aligns interests across payers providers and healthcare consumers. This platform serves more than 750 payers including the top 5 national health plans BCBS insurers regional health plans TPAs and selfinsured employers and millions of healthcare providers and consumers. Zelis sees across the system to identify optimize and solve problems holistically with technology built by healthcare expertsdriving real measurable results for clients.
A Little About You
You bring a unique blend of personality and professional expertise to your work inspiring others with your passion and dedication. Your career is a testament to your diverse experiences community involvement and the valuable lessons youve learned along the way. You are more than just your resume; you are a reflection of your achievements the knowledge youve gained and the personal interests that shape who you are.
Position Overview
The Claims Settlement Specialist supports claim settlement with providers through post payment negotiation. The Regulated Claims Settlement Specialist will be responsible for handling provider disputes and formal appeal processes under Federal and State regulated settlement programs. During this process the Regulated Claims Settlement Specialist must understand: (1) the procedures billed on the claim/bill; (2) the estimate of the fair value of the payment that was remitted to under the applicable Federal or State law location/facility/provider comparisons and Zelis proprietary evaluation software; (3) identify negotiation points for that particular provider or service if payment is not accepted as is; and when required or reasonable under the applicable law negotiate an acceptable payment settlement within the required timeframe for the applicable Federal or State law.What youll do:
Providing a formal response to providers who have submitted pricing disputes through formal settlement or arbitration processes
Evaluating supporting documentation or arguments presented by providers to determine if a settlement above the applied pricing is warranted
Answering calls from providers who are questioning the paid amount on any claim(s) handled by Zelis for payor.
Returning all calls within one business day of receiving the call.
Address newly assigned work within 48 hours of receipt.
Creating payment negotiation documents using proprietary programs and transmitting those via fax email or other methods.
Documenting stages of process and outcome of post payment negotiation in custom database.
Analyzing medical claims and applicable federal or state laws and being able to discuss them with specific providers.
Negotiating claims within applicable federal and state law parameters and timeframes as required.
Performs other related responsibilities as assigned.
What youll bring to Zelis:
Three years or more experience in healthcare collections billing or claim negotiations
Demonstrated success in a sales or contract negotiations setting
Knowledge of the full Microsoft Office Suite of products to include but not limited to MS Outlook MS Word MS Excel and MS PowerPoint
A background in healthcare collections provider billing retail or sales is beneficial.
4year college degree preferred.
Maintains confidentiality and handle sensitive material.
Demonstrates solution orientation; takes initiative when resolving challenges or improving process.
Displays selfmotivation and the ability to work independently and as a team.
Demonstrates ability to balance and prioritize workload from various service units and individuals in a fastpaced environment.
Demonstrated motivation to provide fast accurate and complete customer service at all times to employees external contacts and management.
Recognizes deviations from expected observations.
Calls attention to results that require analysis.
Completes work in a timely fashion and in accordance with established deadlines. Alerts leadership in advance if deadlines are unable to be achieved.
Ability to effectively communicate with active listening and persuasive speaking skills.
Strong analytical public speaking and negotiation skills.
Location and Workplace Flexibility
We have offices in Atlanta GA Boston MA Morristown NJ Plano TX St. Louis MO St. Petersburg FL and Hyderabad India. We foster a hybrid and remote friendly culture and all our employees work locations are based on the needs of the position and determined by the Leadership team. Inoffice work and activities if applicable vary based on the work and team objectives in accordance with Company policies.
Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment 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.
We welcome applicants from all backgrounds and encourage you to apply even if you dont meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.
Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process please email .
Disclaimer
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race color religion sex gender identity national origin disability status protected veteran status or any other characteristic protected by law.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities duties and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities duties and skills from time to time.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
