Claims Support Specialist
The Claims Support Specialist will provide daily operational support to the Expert Claims Review (ECR) team. They will work closely with Document Retrieval, Concept Development, DRG and Itemized Bill Review teams to ensure adherence to company policies and procedures for claims processing to support internal inventory management.
Claim data entry in multiple platforms
Group claim data including demographics, diagnosis and procedure codes utilizing the encoder
Repricing of claims and claim management
Verify and process contracted client DRG revisions and repricing
Monitor queues and screen claims based on ECR prioritization and client requirements
Participate in new client implementations
Perform overflow tasks to support Itemized Bill Review product
Collaborate between multiple areas within the department as necessary
Assist with monitoring and analyzing product performance reports
Maintain awareness of and ensure adherence to Zelis standards regarding privacy
Skills, Knowledge, and Experience
Experience with health/medical insurance and handling of claims required
General knowledge of provider claims/billing experience preferred
General knowledge medical coding experience preferred, including ICD-10 and CPT coding
Strong organization skills with attention to detail
Outstanding verbal and written communication skills
Ability to work proactively to ensure proper follow-up and completion of projects
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.
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
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