Medical Bill Navigator

Position Overview

What you will do:

• Analyze medical claims submitted by members along with their Explanation of Benefits (EOB) to verify accuracy of claim processing and provider billing

• Manage and resolve member cases involving claim processing issues provider billing inaccuracies and balance billing concerns

• Assist members with a variety of claim-related inquiries

• Provide member education on claim processing and benefit application with the ability to explain medical billing and insurance concepts in a clear and empathetic manner

• Communicate with medical providers to perform claim research and address billing discrepancies when identified

• Engage in provider negotiations to reduce outstanding member balances

• Collaborate with members health plans to research claim issues and ensure accurate claim processing resolutions

• Provide ongoing case follow-up to ensure timely and successful resolution

• Assist with Intake Specialists handling of member portal submissions

• Assist in training initiatives to enhance team knowledge and efficiency

• Adhere to Key Performance Indicators (KPIs) set forth by management in relation to member support

• Maintain high standards of accuracy and quality on all member case work and communications

• Adhere to Zelis and regulatory privacy standards to guard protected health information

• Must be available to travel as required to meet business needs

What youll bring to Zelis:

• Bachelors Degree

• 5 years of medical claims & member benefit application experience

• Strong analytical and problem-solving skills to investigate and resolve complex billing and claims issues

• Exceptional organizational skills

• Excellent communication skills both verbal and written and skilled at developing and maintaining effective working relationships.

• Excels working in both an independent capacity and team environment

• Proficient knowledge of Microsoft Outlook Word Excel

Base Salary Range

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors including experience education qualifications as well as job-related and industry-related knowledge and skills etc. Base pay is just one part of our Total Rewards package which may also include discretionary bonus plans commissions or other incentives depending on the role.

Zelis full-time associates are eligible for a highly competitive benefits package as well which demonstrates our commitment to our employees health well-being and financial protection. The US-based benefits include a 401k plan with employer match flexible paid time off holidays parental leaves life and disability insurance and health benefits including medical dental vision and prescription drug coverage.