Position Overview

The Claims Settlement Manager is responsible for the leadership and continuous development of the post payment claim settlement team. As the team leader, the Manager will be accountable for exceeding department business objectives to drive best in class claim settlement while collaborating with cross functional partners to support our Out of network and Reference Based Pricing products.

Key Responsibilities

• Manage people, process and technology required to deliver leading edge customer experience related to post payment claim settlement for clients, providers, and members

• Drive initiatives and recommendations for inquiry management and resolution process and system improvements to optimize accuracy and efficiency

• Interact with internal and external clients to aid in retaining maximum savings, building relationships and supporting the team in achieving all relevant goals and KPI’s

• Manage operations by monitoring system performance; identifying and resolving problems; preparing and completing action plans; completing system audits and analyses; managing quality assurance programs

• Manage staffing levels and team structure to optimize performance, including planning, assigning, and directing work

• Resolve escalated inquiries from providers, clients and internal teams

Preferred Qualifications

• 7+ years of healthcare claims related experience

• People leadership experience with the ability to motivate, empower and drive collaboration

• Demonstrated expertise in claim settlement and advocacy services

• Bachelor’s degree

• Excellent communication and interpersonal skills

#LI-RZ1

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

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