Regulated Claims Settlement Coordinator

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 Regulated Claims Settlement Coordinator supports the Claims Settlement Team through leading the review and response to disputed claims submitted through state and federal arbitration processes. The Regulated Claims Settlement Coordinator will be responsible for supporting Zelis’ settlement offers and pricing after disputes have been filed to federal and state arbitrations, packaging and summarizing objective data and the arguments in support of Zelis’ position. The Regulated Claims Settlement Coordinator will collaborate with other team members and leadership to process and manage IDR inventory regulated by Federal or State law.

JOB DESCRIPTION

ABOUT ZELIS:

As the leading payments company in healthcare, we price, pay and explain healthcare for payers, providers, and healthcare consumers. Zelis was founded on a belief there is a better way to determine the cost of a healthcare claim, manage payment-related data, and make the payment because more affordable and transparent care is good for all of us. We partner with more than 700 payers, including the top-5 national health plans, Blues plans, regional health plans, TPAs and self-insured employers, 1.5 million providers and millions of members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and an integrated pre-payment through payments platform to manage the complete payment process.

Position Overview:

The Regulated Claims Settlement Coordinator supports the Claims Settlement Team through leading the review and response to disputed claims submitted through state and federal arbitration processes. The Regulated Claims Settlement Coordinator will be responsible for supporting Zelis’ settlement offers and pricing after disputes have been filed to federal and state arbitrations, packaging and summarizing objective data and the arguments in support of Zelis’ position. The Regulated Claims Settlement Coordinator will collaborate with other team members and leadership to process and manage IDR inventory regulated by Federal or State law.

Key responsibilities:

• Prepares and presents Zelis’ response packages to cases submitted for arbitrations at both the state and federal level under the NSA
• Provide input and guidance on the selection process for certified arbitration entities under the NSA
• Create a scalable IDR defense package through improved automation in the creation and compilation of the necessary data elements
• Respond to Notice of offer requests using proprietary programs to calculate an offer
• Draft brief to provide analysis dispute along with objections to support client positions in arbitration packages pursuant to federal regulations.
• Ensure Claims Settlement processes deliver required information for arbitration reviews and position Zelis for optimal success
• Documenting stages of IDR process and outcomes within internal database and maintain an accurate record.
• Communicate with IDRE’s, Clients and Providers as needed to request or provide additional information
• Provides monthly performance reporting to departmental leadership.
• Adjusting claim to agreement and/or ruling amount
• Maintain department productivity and quality standards
• Confirms that all documentation adheres to Zelis standards regarding privacy, compliance, legal aspects, and HIPAA standards.
• Ensures all cases remain compliant with required timelines for responses and required Zelis input
• Performs other related responsibilities as assigned.

Professional experience:

• 1 year or more experience in healthcare, health insurance, or healthcare compliance
• Demonstrated success in arbitration, mediation, or contract negotiation setting
• Knowledge of the full Microsoft Office Suite of products to include, but not limited to, MS Outlook, MS Word, MS Excel, and MS PowerPoint
• A background in healthcare collections, provider billing, negotiations or compliance is beneficial. 

Education:

• Bachelor’s degree preferred

Independence/ Accountability:

• Maintains confidentiality and handle sensitive material.
• Demonstrates solution orientation; takes initiative when resolving challenges or improving process.
• Displays self-motivation and the ability to work independently and as a team.
• Demonstrates ability to balance and prioritize workload from various service units and individuals in a fast-paced environment.
• Provides provide detailed and clear written documentation of processes and policies.
• Demonstrates motivation to provide fast, accurate, and complete reporting at all times to employees and management.

Problem Solving:

• Recognizes deviations from expected observations.
• Calls attention to results that require analysis.
• Completes work in a timely fashion and in accordance with established deadlines.  Alerts leadership, in advance, if deadlines are unable to be achieved.
• Possesses attention to detail.

Leadership Activities:

• Provides feedback to leadership regarding progress of ongoing projects and product performance.
• Demonstrates a proactive approach to ensure proper follow up and completion of projects.
• Maintains a professional demeanor in sensitive situations.
• Assists other departments as necessary.
• Exhibits a “passion” for process improvement.

Communication Skills:

• Ability to effectively communicate with active listening and persuasive speaking skills.
• Strong analytical, public speaking and negotiation skills.