OON Claims Optimization Specialist

Position Overview :

As part of the Price Optimization division, this role will be depended on as an Operations SME to support clients through areas including but not limited to implementations, escalated routing / pricing issues, data intel, and product nuances to provide a favorable client experience.

This role will also develop and monitor OON KPI's to ensure quality performance to address volume / performance concerns.

What you will do :

Expert on the OON product including but not limited to client customizations and routing.

Manage, Investigate, and Solution client routing / pricing issues that may result in loss of Revenue / savings or client satisfaction concerns.

Partner with Account management to assist with client concerns / initiatives including but not limited to Volume, performance, product initiatives, set up, etc.

Monitor OON KPI's to ensure product performance to furthermore investigate both positive and negative trends to understand the underlying reasons.

Support implementations as a Product SME to provide direction on client set up and product nuances.

Support Sales in providing OON historical data including but not limited to experience across providers, provider types, market segments, etc.

Partner with OON Mgmt to define ongoing KPI's to ensure Quality product performance including but not limited to volume, performance, and claim mix

Develop and maintain efficient dashboard reporting related to KPI's that include providing requirements from inclusion criteria to outputs.

Analyze product trends to provide automation and product initiatives to drive further savings / revenue and efficiencies.

Provide data insights as requested by collecting data, conducting analysis, and producing outputs

Collaborate cross-departmentally to achieve results as intended.

Maintain awareness of and ensure adherence to Zelis standards regarding privacy.

Must be available to travel 25% - 50% as required to meet business needs.

What you will bring :

Bachelor's Degree or historical equivalent experience.

A self-starter with an ability to research and resolve issues

Management of strategic operational and technology initiatives. Experience managing projects and process innovative changes effectively.

Strong working knowledge of MS Excel, computer systems, applications and operating systems.

Strong analytical skills to be able to provide insights from gathering requirements to presenting outputs

Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships.

Excellent skills in critical thinking and analysis, project management, meeting facilitation, and interpersonal interactions (e.

g., partnering, conflict management, consulting, etc.)

Ability to create and document workflow processes

SQL experience preferred but not mandatory

Location and Workplace Flexibility : We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St.

Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture and all of our employee's work locations are based on the needs of the position and determined by the Leadership team.

In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.

Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers.

This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers.

Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients.

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 qualified 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 [email protected] .

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.