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Director, Out of Network Services

Zelis

Zelis

This job is no longer accepting applications

See open jobs at Zelis.
Remote
Posted on Thursday, December 21, 2023

Key Responsibilities:

  • Manage and/or work with all associates and managers within the OON Services department at all business locations; inventory management, train, coach and motivate staff to ensure optimal performance
  • Meet and/or exceed monthly and annual goals; report out regularly to leadership on progress
  • Mentor and coach staff and people leaders in the organization
  • Instill a growth mindset within the team; drive a continuous improvement culture
  • Assist VP and/or Solutions Owner in developing strategies to continuously improve revenue / cost savings opportunities through product introductions/enhancements, process enhancements, and system efficiencies.
  • Manage escalated internal & external issues such as provider disputes, SLAs, special requests, etc.
  • Assist associates with troubleshooting all system related issues
  • Create development opportunities for staff that benefit employees and the organization
  • Work closely with internal & external stakeholders to provide a concierge customer service experience; partner with Client services and Account Management as needed
  • Partner with People Operations on employee relations issues, recruitment efforts and HR needs for the department.
  • Maintain awareness of and ensure adherence to Zelis’ standards regarding privacy.

Professional Experience:

  • Minimum of 7 -10 years’ experience in healthcare;
  • Healthcare claims dispute management experience preferred
  • Minimum of 3-5 years’ experience as a people leader
  • Demonstrated expertise in operational management including KPIs, inventories, etc.
  • Experience with managing client relationships
  • Expertise in both fully insured and self-insured market segments

Education:

BS Degree preferred plus Professional Experience as indicated above

Work Environment:

  • Travel requirements to (primarily) domestic destinations should not exceed 20%.
  • A standard work week exists but with the understanding that additional time/effort outside of the usual parameters can/will occur based upon the overall needs of the integration, where deadlines exist and when necessary due to the needs of the integration team.
  • A standard business environment exists with moderate noise levels.
  • Ability to sit for extended periods of time.

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.

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 TalentAcquisition@zelis.com

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.

This job is no longer accepting applications

See open jobs at Zelis.