​Position Overview:

The Claims Analyst primary focus is responsible for claims processing including, but not limited to, processing incoming Medical and Dental claims received by clients, utilizing multiple fee schedules, online re-pricing and forwarding to the appropriate network according to network participation.

Key Responsibilities:

• Maintains HIPAA guidelines within business units.
• Communicates with networks in follow-up of outstanding claim repricing’s.
• Analyzes claim routing discrepancies and determines where a claim should route based on specific client and/or /network parameters.
• Coordinates repricing and re-routing of claims by assigning networks while maintaining qualitative and quantitative standards.
• Completes revisions to repriced claims as requested
• Verifies contractual actuaries before repricing claims using loaded fee schedules
• Identifies system issues
• Closely monitors and exceeds, when possible, client claim processing turnaround times (TAT).
• Completes miscellaneous tasks/ manager as assigned by supervisor, manager, or other member of the leadership team.
• Review claims to ensure correct pricing has been applied in accordance with CDAs and other standardized repricing agreements.
• Backup Analysts on their assigned networks as needed.

Professional Experience:

• High School Diploma required. Associate’s degree in related field preferred.
• 2+ years of experience within the healthcare industry preferred.
• Experience with health/medical insurance and processing of claims.

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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

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