At Zelis, we Get Stuff Done. So, let’s 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. 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 you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview The Manager, Claims Negotiations, will oversee various functions within the Out of Network Services Department. This includes assisting in the supervision of Claim Negotiators, closely monitoring claim volume and turnaround time, as well as new client claims, revenue opportunities, and savings quotas. Additionally, the Manager will actively contribute to the improvement and development of policies and procedures. What you will do: + Monitor and track overall claim activity related to fee negotiations and ensuring compliance with all turnaround time requirements. + Manage a dedicated team of Claim Negotiators responsible for negotiating claims, providing direction on negotiations, utilizing tools and resources effectively, and tracking performance. Conduct regular reviews of quotas on a monthly and quarterly basis. + Assist in the daily distribution of claims to appropriate team members. + Review and process non-acceptances during the day to ensure appropriateness and identify potential savings opportunities. + Identify specific claims that require processing outside the client's normal services and seek client approval for processing according to Zelis' recommendations. + Participate in the interview process for new staff and train new Claim Negotiators using relevant training materials, regularly reviewing, and updating training materials. + Provide ongoing education and training to the Claim Negotiators through meetings and seminars. + Work in close coordination with the Provider Services Department to address provider issues, including contract and discount disputes. + Regularly review all Standard Operating Procedures for the Claim Negotiators to ensure they are up-to-date and accurate. + Maintain a keen awareness of and ensure strict adherence to Zelis' standards regarding privacy and data protection. Leadership Activities: + Ensures comprehensive training for newly onboard Claim Negotiators, providing leadership with regular feedback on their progress. + Offers constructive feedback to leadership on the ongoing development and performance of the Claim Negotiator team. + Demonstrates a proactive approach to ensure timely follow-up and successful completion of projects. + Maintains a professional and composed demeanor, especially in sensitive situations. + Demonstrates a strong commitment to developing the skills and abilities of the Claim Negotiator team, showing a genuine passion for their growth and success. What you will bring: Required + Five years or more experience in healthcare claim negotiations or medical claims processing + Demonstrated success in a medical claims contract negotiation 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 medical claims processing, provider billing, medical claim coding is beneficial. + Must have previous experience managing a production environment and meeting strict turnaround time and quality standards. + Must be able to utilize special company systems and software. Work environment + A standard work week exists but with the understanding that additional time/effort outside of the usual parameters can/will occur based upon the overall needs of the business unit and team. + A standard business environment exists with moderate noise levels. + Ability to lift and move approximately thirty (30) pounds on a non-routine basis. Ability to sit for extended periods of time. 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 employee's work locations are based on the needs of the position and determined by the Leadership team. In-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 don’t 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 TalentAcquisition@zelis.com . 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. 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.