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Healthcare Claims Negotiator

Sapphire Digital

Sapphire Digital

Morristown, NJ, USA · Morristown, TN, USA · Texas, USA · Boston, MA, USA · Boston, MA, USA · St. Petersburg, FL, USA · Petersburg, VA, USA · Atlanta, GA, USA · Atlanta, GA, USA · Missouri, USA
Posted on Thursday, August 10, 2023

Job Description:

As a Healthcare Claims Negotiator, you will be responsible for cultivating and sustaining strong rapport with providers. Your primary objective will be to optimize cost savings for our clients by skillfully navigating their policies and adhering to relevant regulations.

Key Responsibilities:

  • Engage in negotiations with medical providers to secure the highest discounts and savings for out-of-network claims submitted to Zelis.
  • Collaborate with medical providers through a combination of leveraging existing out-of-network claims and proactively reaching out via cold calls to Individual Physician Associations (IPA's) and billing companies, aiming to create bulk contracting opportunities.
  • Monitor the In-Process Claims Report closely to meet the specified turnaround times expected by each client.
  • Provide assistance to providers in resolving any disputes or issues that may arise.
  • Facilitate effective communication with the Client Service Associate, responding to claim inquiries as required by the providers.
  • Collaborate with various departments within Zelis Enterprise, including the Claims Integrity Division, to foster a cohesive working environment.
  • Maintain a keen awareness of and ensure strict adherence to Zelis standards concerning privacy and confidentiality.

Technical Skills/Knowledge:

  • Exhibits a solid grasp of navigating claims and provider systems to optimize savings for clients.
  • Demonstrates a growing comprehension of the technical aspects related to claims negotiation, master contracts, and usual/customary charges.
  • Tackles complex assignments that demand sound judgment and proactive problem-solving to formulate recommendations.
  • Displays proficiency in using computer systems, including proprietary software and MS Office applications.
  • Possesses comprehensive knowledge of company and departmental policies and procedures.
  • Quickly learns and assimilates additional tools and software essential for enhancing the negotiation process on a daily basis.

Education:

  • Bachelor's degree or equivalent relevant work experience.
  • A minimum of 3 years of experience in processing medical claims.
  • Strong verbal communication skills.
  • Outstanding organizational abilities.
  • Proficiency in using MS Office applications.

#LI-GC1

As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.

Commitment to Diversity, Equity, Inclusion, and Belonging
At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All 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 encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.

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

SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you’re contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.