Sr. Director, Claims Pricing

At Zelis we Get Stuff Done. So lets get to it!

A Little About Us

Zelis is modernizing the healthcare financial experience across payers providers and healthcare consumers. We serve more than 750 payers including the top five national health plans regional health plans TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify optimize and solve problems holistically with technology built by healthcare experts driving real measurable results for clients.

At Zelis AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo accelerate innovation and amplify their impact. This is a place for builders with a growth mindset who act with agility embrace change and use modern technology to shape smarter solutions exceptional experiences and the future of our industry for our clients customers and our culture.

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

As part of the Pricing Solutions division this role leads strategic initiatives that improve the performance efficiency scalability and future readiness of the Claims Pricing & Revenue organization. This role works closely with Claims Pricing & Revenue leadership to translate business priorities into actionable plans strengthen operating performance and identify opportunities to modernize claims pricing repricing negotiation and related revenue operations.



Initially serving as a senior individual contributor the Senior Director leads complex cross-functional work through influence subject-matter expertise and strong execution. The role may lead a team in the future as the organizations transformation agenda and capabilities expand.

The Senior Director partners across Operations Product Technology Analytics & Insights Finance Networks Client Services and other key stakeholders to improve how work is performed and measured. The role will be particularly focused on identifying and implementing AI automation globalization and workflow opportunities that improve productivity quality turnaround time cost-to-serve and margin performance.

What you will do:

Strategic Initiatives and Functional Transformation

• Lead high-priority initiatives that advance the Claims Pricing & Revenue strategy and improve the organizations long-term performance.

• Translate strategic priorities into practical roadmaps work plans milestones ownership and measurable outcomes.

• Identify opportunities to simplify work reduce fragmentation eliminate unnecessary handoffs and improve coordination across claims pricing repricing and negotiation functions.

• Evaluate current operating practices and recommend changes that improve scalability consistency quality and margin performance.

• Lead initiatives that span multiple products operational teams systems or stakeholder groups.

• Surface risks dependencies resource requirements and tradeoffs to support leadership decisions and prioritization.

AI Automation and Operational Innovation

• Partner key stakeholders and operational leaders to identify high-value AI automation and workflow opportunities.

• Assess opportunities based on operational impact feasibility capacity released quality improvement cost risk and expected return.

• Develop implementation plans that clearly define the business need expected outcome workflow change resource requirements adoption approach and performance measures.

• Help move initiatives from concept through implementation by coordinating the appropriate operational product technology and business stakeholders.

• Identify repeatable capabilities that can be standardized or scaled across claims pricing and revenue teams.

• Support globalization strategies responsibly while maintaining quality regulatory compliance and client performance.

• Monitor adoption and business results to ensure implemented solutions deliver the intended value.

Claims Pricing and Revenue Operations Optimization

• Develop an end-to-end understanding of claims pricing repricing prepay and post-pay negotiations revenue realization and associated operational workflows.

• Identify opportunities to improve throughput accuracy cycle time quality workforce utilization and cost-to-serve.

• Partner with operational leaders to address performance gaps bottlenecks duplicative work and inconsistent processes across teams.

• Recommend operating-model workflow resource or capability changes that enable the function to scale efficiently.

• Ensure operational improvements support the commercial financial regulatory and client commitments of the business.

• Support evaluation of which activities should be automated standardized centralized globalized redesigned or discontinued.

Operational Performance KPIs and Feedback Loops

• Partner with Analytics & Insights and Process Excellence to define the KPIs required to manage Claims Pricing & Revenue performance.

• Establish measures for productivity throughput quality cycle time automation adoption negotiation outcomes resource utilization cost-to-serve and other relevant business results.

• Help to ensure capacity models are developed to support the operations of the business.

• Ensure leaders have clear reliable dashboards and performance insights that support timely decisions.

• Analyze performance trends and identify emerging risks recurring issues and opportunities for improvement.

• Establish feedback loops among Business Operations Product Strategy Product Delivery Technology Finance and Process Excellence.

• Use operational findings to inform product enhancements technology priorities process changes workforce plans and future strategic initiatives.

• Measure the impact and return of operational changes and recommend adjustments where expected benefits are not being achieved.

Cross-Functional Leadership and Partnership

• Serve as a strategic advisor to Claims Pricing & Revenue leadership on operating performance transformation priorities and organizational opportunities.

• Lead cross-functional initiatives without relying on direct reporting authority.

• Build alignment across teams with different priorities operating models and areas of expertise.

• Partner with Finance on profitability analysis financial implications capacity investments cost-to-serve and business cases while preserving Finances ownership of product pricing and financial validation.

• Partner with Product Strategy to communicate operational needs recurring client themes and capability opportunities that may affect product direction.

• Partner with Product Delivery and Technology to translate approved priorities into implementable solutions.

• Partner with Process Excellence on work intake prioritization process redesign adoption and measurement.

• Communicate progress risks decisions and results clearly to senior leaders and other stakeholders.

Client Escalations

• Lead or coordinate resolution of select complex and high-impact client escalations.

• Bring together the appropriate operational client product technical compliance network and financial stakeholders.

• Clarify accountability action plans timelines communications and decision points.

• Distinguish immediate client resolution from longer-term systemic improvement.

• Identify recurring escalation themes and use them to inform process product training or operating-model changes.

• Ensure resolutions are sustainable and do not create unnecessary manual work or operational risk.

Organizational Capability and Workforce Readiness

• Identify the skills roles capacity and operating capabilities required to execute the future Claims Pricing & Revenue strategy.

• Support workforce planning and recommendations related to upskilling reskilling globalization role redesign and future hiring.

• Develop repeatable approaches tools and frameworks that improve how strategic initiatives are managed across the function.

• Support change adoption by helping leaders and teams understand new workflows responsibilities performance expectations and measures.

• If the role develops into a people-leadership position build and lead a high-performing team focused on strategic initiatives and functional transformation.

• Must be available to travel 25% - 50% as required to meet business needs.

What you will bring:

Required

• Bachelors degree in a related field or commensurate experience.

• 12 years of progressive experience in healthcare operations claims pricing reimbursement payment integrity revenue operations consulting transformation or a related field.

• Significant experience leading complex cross-functional initiatives with measurable operational or financial outcomes.

• Demonstrated knowledge of healthcare claims pricing repricing reimbursement negotiations payer operations or related revenue workflows.

• Experience identifying and implementing automation AI workflow or technology-enabled operational improvements.

• Experience developing performance measures operational dashboards business cases or benefit-realization plans.

• Experience influencing senior leaders and driving decisions in a highly matrixed environment.

• Experience managing complex client or business escalations preferred.

• People-leadership experience is beneficial but not required at appointment; the ability to build and lead a future team is important.

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

Zelis is headquartered in the U.S. with multiple locations across the country and in Hyderabad India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership -office work and activities vary based on work and team objectives in accordance with Company policies.

While location expectations vary by role candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible and in-office presence is guided by team and business needs rather than a fixed weekly schedule.

Base Salary Range

$169000.00 - $213750.00

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.

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.