Position Summary:
The Healthcare Claims Negotiator will build and maintain outstanding relationships with providers and while adhering to client’s policies and regulations, maximize savings amount for client.
Essential Functions:
- Contact medical providers to negotiate greatest discount/savings on out of network claims submitted to Zelis
- Contract with medical providers by utilizing out of network claim on hand as well as cold calling providers, Individual Physician Association (IPA’s), billing companies in order to generate bulk contracting opportunities
- Monitor In-Process Claims Report in order to meet each client’s expected turnaround time
- Assist providers on any related dispute/issue
- Communicate with Client Service Associate on claim inquires as requested per provider
- Work along other departments within the Zelis Enterprise including but not limited to the Claims Integrity Division
- Maintain awareness of and ensure adherence to Zelis standards regarding privacy
Technical Skills/Knowledge:
- Has a foundational proficiency in navigating claims and provider systems to achieve maximized savings for clients
- Has a developing understanding of relevant technical aspects of claims negotiation, master contracts and usual/customary charges
- Works on assignments that are complex in nature where judgment and initiative are required in resolving problems and making recommendations
- Computer proficiency and technical aptitude with the ability to utilize proprietary system and MS Office applications
Independence/Accountability:
- Requires minimal daily supervision
- Receives detailed instructions on new assignments and determines next steps with guidance
- Regularly reviews goals and objectives with supervisor
- Ability to manage and prioritize multiple tasks
- Ability to work under pressure and meet deadlines
Minimum Qualifications/Credentials (if any):
- 3+ years healthcare experience
- Negotiation experience a plus
- Excellent verbal communication skills
- Exceptional organizational skills
- Proficient knowledge of MS Office applications
- Detail-oriented and able to work in a fast paced environment
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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.
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.
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