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Manager, Out of Network Post Pay Solutions

Sapphire Digital

Sapphire Digital

Multiple locations
Posted on Tuesday, July 9, 2024

Position Overview

The Manager, Out of Network Post Pay Solutions will be responsible for the training, mentoring and overall supervision of Claims Settlement team members. This is inclusive of monitoring daily workflows/volumes and production, allocating resources to ensure timeliness of dispute response, ensuring attendance and scheduling needs are met, documenting and reinforcing departmental policy/procedure to exceed both client and Zelis expectations for dispute resolution. Will 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.

Key Responsibilities

  • Manage people, process and technology required to deliver leading 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.

  • Establish key performance indicators and coach employees toward performance and development objectives.

  • 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.

  • Manage daily workflow and inventory volumes to allocate resources to cover inventory as appropriate.

  • Resolve escalated inquiries from providers, clients and internal teams.

Qualifications

  • 4+ years of healthcare claims and/or provider dispute related experience

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

  • Experience with State Mediation/Arbitration

  • Demonstrated expertise in claim settlement and advocacy services

  • Excellent communication and interpersonal skills

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.