Claims Negotiator

Zelis

Bedminster, NJ

Expired: over a month ago Applications are no longer accepted.

Full-Time

Job Description

Zelis is a healthcare information technology company and market-leading provider of end-to-end healthcare claims cost management and payment solutions.

Inc.5000 award winner: One of the fastest growing privately held companies in the US!

Ranked #1 by NJ Biz as the Fastest Growing Company in NJ!

COMPANY BACKGROUND/CULTURE

We spend more than $3 trillion each year on healthcare in our country.

We believe there’s a way to reduce the rising cost of healthcare by $1 trillion.

We formed Zelis to help deal with the unacceptable level of errors, waste and abuse.

We’ve brought together some of the best leaders in the business of helping control the rising cost of healthcare to help make healthcare more affordable for all of us. It’s working even better than we imagined. Zelis has helped more than 500+ payers save more than $24+ billion in network and claim cost savings. We’ve delivered more than $19+ billion in payments on behalf of 150 payers to 560,000 contracted providers with access to more than 1.5MM providers.

We’re a market-leading healthcare technology company that’s integrating healthcare cost management and payments to pull waste from the system. By connecting the dots, we’ve built the Zelis Intelligent Claim Routing Platform, a single, real-time technology interface that powers our fully integrated healthcare cost management and payment solutions. Where payers get the right information to create the networks their members need, where claims get paid appropriately, and where payments are delivered faster, more accurately, and more efficiently.

More than 85% of the time, we identify additional network cost, claims cost and payments cost savings other companies are unable to find. That’s because we’re more than 1000+ people working as one with payers and providers to deliver industry-leading levels of service and performance.

Every network. Every claim. Every payment. Every day.

We’re helping make healthcare more affordable for all of us. Because we’re all in this together.

Zelis is backed by Parthenon Capital Partners and Bain Capital PE.

___________________________________________________________________________________________________________________________________________

ZELIS HIGHLIGHTS

Zelis is a market-leading healthcare technology company providing integrated

healthcare cost management and payments solutions including network analytics

and design, network access and cost management, claims cost management and

electronic payments to payers, healthcare providers and consumers in the

medical, dental and workers’ compensation markets nationwide.

Zelis is backed by Parthenon and Bain Capital Partners. www.Zelis.com

Locations:

Bedminster, NJ (HQ);

4 Campus Locations in GA, FL, KS,

MO; 6 satellite offices

Headcount:

1000+ associates

Clients:

• 700+ payer clients

• 1.5+MM network providers

Scale:

$27+B in network & claims cost

$25+B in payments, with 700k

contracted providers and access to 1.5+M providers

Our Zelis Purpose

We founded Zelis to help control the rising cost of healthcare and make healthcare more affordable for all of us.

Position Overview

The Claims Associate will build and maintain outstanding relationships with providers and while adhering to client’s policies and regulations, maximize savings amount for client.

KEY RESPONSIBILITIES

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.

professional experience/qualifications

Has a foundational proficiency in navigating claims and provider systems in order 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
Thorough knowledge of company and departmental policies and procedures
Ability to learn and understand Additional tools and software provided to use in every day negotiation process

Education

3+ years experience with claims processing
Excellent verbal communication skills
Exceptional organizational skills
Proficient knowledge of Microsoft Outlook, Word, and Excel
Detailed-oriented and able to work in a fast paced environment.

COMPENSATION:

An attractive compensation package comprised of base salary, plus incentives, as well as full benefits has been created to attract outstanding candidates.

OUR BIG 8 ZELIS VALUES