Claims Settlement Specialist

Zelis is a healthcare information technology company and market-leading provider of end-to-end healthcare claims cost management and payment solutions.

Inc.5000 award winner: One of the fastest growing privately held companies in the US!

Ranked #1 by NJ Biz as the Fastest Growing Company in NJ!

COMPANY BACKGROUND/CULTURE

Zelis Healthcare is an information technology company which utilizes an end-to-end technology platform to fulfill the claims cost management and payments needs of healthcare payors including large and medium-sized health plans, TPAs, Taft-Hartley Plans, providers and individuals.
The company provides a comprehensive portfolio of network management, claims integrity, payment remittance solutions and analytical services for medical, dental and workers’ compensation claims to over 500 payor clients.
Additionally, the company delivers electronic payments and explanation of payments to over 200,000 healthcare providers and serves individuals with provider lookup and medical referral services.

Position Overview

The Claims Settlement Specialist position will handle the financial settlement of medical claims/bills on behalf of Zelis payor clients. The Claims Settlement Specialist will be responsible for handling provider telephone calls regarding the payment amount paid to a provider by a payor based on Zelis data points. During this call, the 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 the provider based on Medicare pricing, location/facility/provider comparisons, and Zelis proprietary evaluation software; (3) identify negotiation points for that particular provider if payment is not accepted, as is; and, (4) negotiate an acceptable payment below the providers billed charges.
This position requires a minimum 60-day training period.

KEY RESPONSIBILITIES
* Answering all 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.
* Creating payment negotiation documents using Word, Excel, or proprietary programs and transmitting those via fax, e-mail or other methods.
* Documenting stages of process and outcome of post payment negotiation in custom database.
* Analyzing medical claims and being able to discuss them with specific providers.
* Negotiating claims/bills as required.
* Miscellaneous duties as assigned

PROFESSIONAL EXPERIENCE/QUALIFICATIONS
* A background in healthcare collections, provider billing, retail or sales is beneficial.
* Ability to effectively communicate including listening and persuasive speaking skills and abilities.
* Excellent analytical and critical thinking skills as well as conversation skills and negotiation skills are a must; skills to make quick connections between many pieces of information and synthesize that into effective conversations.

COMPENSATION:

An attractive compensation package as well as comprehensive benefits plans are available to attract outstanding candidates.

Thank you for your interest in the Zelis team!