Senior Edit Resolution Analyst, CPCCCS

Position Overview

What Youll Do:

• Manage escalated and high-risk grievance and appeal cases requiring advanced regulatory knowledge and critical thinking to ensure timely and compliant resolution.

• Serve as a resource for complex inquiries from peers and leadership; interpret regulatory changes and advise on operational impacts.

• Lead or contribute to the creation and refinement of SOPs job aids and training materials to ensure alignment with evolving regulations and organizational goals.

• Provide structured guidance and coaching to junior associates fostering skill development and adherence to quality standards.

• Partner with other teams to address systemic issues mitigate risks and implement corrective actions.

• Identify opportunities for automation workflow redesign and efficiency improvements; present recommendations to leadership.

• Conduct peer reviews and audits of case handling to ensure accuracy compliance and consistency across the team.

• Participate in departmental projects and initiatives aimed at improving grievance and appeals operations and member experience.

• Serve as a subject matter expert on regulatory compliance and dispute resolution.

• Analyze data to identify trends and recommend systemic improvements.

• Drive innovation in resolution practices to enhance member experience and compliance.

What Youll Bring to Zelis:

• CPC or CCS or equivalent credentials required

• 3 yrs related coding experience

• Associates degree preferred

• Requires proficiency using AI tools skillfully with an understanding of how to develop/create intelligent prompts and/or agents

• Advanced knowledge of grievance and appeals handling in healthcare

• Proven ability to coach and mentor junior staff

• Experience in SOP development and process optimization

• Strong problem-solving and communication skills

• Ability to manage elevated and complex cases with minimal supervision

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

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 -office 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

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.