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Claims Support Specialist

Sapphire Digital

Sapphire Digital

Customer Service, Operations
St. Petersburg, FL, USA · Petersburg, VA, USA · St. Louis, MO, USA · Boston, MA, USA · Boston, MA, USA · Atlanta, GA, USA · Atlanta, GA, USA · Morristown, NJ, USA · Morristown, TN, USA · Texas, USA · Park, TX, USA
Posted on Thursday, August 24, 2023

Position Overview

The Claims Support Specialist will provide daily operational support to the Expert Claims Review (ECR) team. They will work closely with Document Retrieval, Concept Development, DRG and Itemized Bill Review teams to ensure adherence to company policies and procedures for claims processing to support internal inventory management.

Key Responsibilities

  • Claim data entry in multiple platforms

  • Group claim data including demographics, diagnosis and procedure codes utilizing the encoder

  • Repricing of claims and claim management

  • Verify and process contracted client DRG revisions and repricing

  • Monitor queues and screen claims based on ECR prioritization and client requirements

  • Participate in new client implementations

  • Perform overflow tasks to support Itemized Bill Review product

  • Collaborate between multiple areas within the department as necessary

  • Assist with monitoring and analyzing product performance reports

  • Maintain awareness of and ensure adherence to Zelis standards regarding privacy

Skills, Knowledge, and Experience

  • Experience with health/medical insurance and handling of claims required

  • General knowledge of provider claims/billing experience preferred

  • General knowledge medical coding experience preferred, including ICD-10 and CPT coding

  • Strong organization skills with attention to detail

  • Outstanding verbal and written communication skills

  • Ability to work proactively to ensure proper follow-up and completion of projects


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.