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
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