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Manager, Adjudication Partnership

Sapphire Digital

Sapphire Digital

Sales & Business Development
Multiple locations
Posted on Friday, February 9, 2024

Position Overview

As a Manager, Adjudication Partnership, you will play a pivotal role in optimizing our adjudication partner relationships, enhancing client satisfaction, establishing efficiencies between operational & product teams within Zelis, our Clients, and our Adjudication Partners, and will be responsible driving internal operational improvements where aligned with our Adjudication Partners.

Key Responsibilities

  • Cultivate and maintain strong relationships with existing vendors, as well as internal Zelis teams including, but not limited to, sales, solutions, and product owners

  • Evaluate vendor performance, vendors fees, and ensure compliance with service level agreements

  • Establish monthly costs absorbed by Zelis associated with each Vendor

  • Develop strategies for onboarding new vendors and optimizing the performance of existing ones, including reestablishing the operational footprints between teams

  • Serve as a primary point of contact for clients, understanding their needs and ensuring exceptional service delivery, including being on client calls during the Implementation process

  • Collaborate with clients to gather feedback surrounding technical improvements needed around technical interfaces

  • Facilitate troubleshooting and bring the right resources to bear in issue management with client and/or vendor partners

  • Implement initiatives to enhance vendor performance, quality, and efficiency

  • Collaborate with vendors to develop improvement plans and ensure alignment with organizational goals

  • Drive continuous improvement through data analysis, feedback loops, and regular performance reviews

  • Work cross-functionally to identify areas for internal process enhancements, including improvements to vendor setup in Zelis systems and financial reporting

  • Escalate to product teams (e.g. EDI, Data, Leadership) as needed for alignment with client and vendor partners

  • Initiate opportunity analysis on standardization for data flows

  • Collaborate with teams to streamline workflows, reduce costs, and enhance overall operational efficiency

  • Implement and monitor key performance indicators (KPIs) to measure the success of operational improvements

  • Serve as subject matter expert in client and sales discussions/meetings regarding data workflow and system integration issues and questions

Preferred Qualifications

  • Bachelor’s degree

  • 6+ years of experience

  • Proven experience in vendor management, client engagement, and process improvement

  • Strong negotiation, communication, and interpersonal skills,

  • Analytical mindset with the ability to use data-driven insights for decision-making

  • Project management experience and familiarity with relevant software tools

  • Strategic thinker with a focus on long-term goals

  • Results-oriented and able to drive positive outcomes

  • Excellent problem-solving skills and a proactive attitude

  • Ability to build and maintain positive relationships with both vendors and clients

  • Strong organizational skills with attention to detail

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.