Analyst II, Resolution
Job Summary
Job Description
- 3-5 years of experience in medical claims settlement
- 5+ years of experience within the healthcare industry
- Understanding of PPO networks and discounts
- Outstanding written and verbal communication skills
- Proficiency in MS Outlook, Word, Excel, and Internet Explorer
- Excellent prioritization and organizational skills
- Exceptional customer service and telephone communication skills
4 skills required
Job Details
About Us
Zelis is modernizing the healthcare financial experience in the United States (U.S.) 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 health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers in the U.S. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts—driving real, measurable results for clients.
Why We Do What We Do
In the U.S., consumers, payers, and providers face significant challenges throughout the healthcare financial journey. Zelis helps streamline the process by offering solutions that improve transparency, efficiency, and communication among all parties involved. By addressing the obstacles that patients face in accessing care, navigating the intricacies of insurance claims, and the logistical challenges healthcare providers encounter with processing payments, Zelis aims to create a more seamless and effective healthcare financial system.
Zelis India plays a crucial role in this mission by supporting various initiatives that enhance the healthcare financial experience. The local team contributes to the development and implementation of innovative solutions, ensuring that technology and processes are optimized for efficiency and effectiveness. Beyond operational expertise, Zelis India cultivates a collaborative work culture, leadership development, and global exposure, creating a dynamic environment for professional growth. With hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations, we foster a holistic workplace experience. Additionally, the team plays a vital role in maintaining high standards of service delivery and contributes to Zelis’ award-winning culture.
Position Overview
The Claims Settlement Coordinator II is responsible for managing the settlement of provider claims, acting as a specialist for the team. This role requires strong negotiation skills, a deep understanding of claims processes, and the ability to support and guide junior team members.Investigate and settle provider and client billing inquiries, including renegotiating claims to secure savings and meet or exceed department KPI goals.
Maintain comprehensive tracking and documentation of all necessary information related to the research and settlement of assigned work.
Collaborate with internal teams, including Client Services, Network and Vendor Management, Out of Network Services, and Bill Review & Audit, to ensure timely resolution of issues.
Recommends process improvement opportunities within team scope.
Communicate directly with clients to provide status updates and resolved issue notifications, maintaining strong customer relations.
Ensure adherence to HIPAA and company standards regarding privacy and confidentiality.
Provide support for the Customer Care Team when required.
Perform other related responsibilities as assigned.
Professional Experience:
3-5 years of experience in medical claims settlement.
5+ years of experience within the healthcare industry.
Strong understanding of PPO networks and the ability to interpret Explanation of Benefits, Plan Documents, PPO, and Complementary Network discounts.
Outstanding written and verbal communication skills.
Proficiency in MS Outlook, MS Word, MS Excel, and Internet Explorer.
Excellent prioritization and organizational skills.
Exceptional customer service and telephone communication skills.
Education:
Associates Degree required. Bachelor's Degree preferred.
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