Claims Settlement Specialist

4 weeks ago

St Petersburg, United States Zelis Healthcare Full time
Job Description

Position Overview:

The Claims Settlement Specialist supports claim settlement with providers through post payment negotiation. The Claims Settlement Specialist will be responsible for handling provider telephone calls regarding the payment amount paid to a provider by a payor based on Zelis data points. During this call, the Claims Settlement Specialist must understand: (1) the procedures billed on the claim/bill; (2) the estimate of the fair value of the payment that was remitted to the provider based on Medicare pricing, location/facility/provider comparisons, and Zelis' proprietary evaluation software; (3) identify negotiation points for that particular provider if payment is not accepted, as is; and, when required, negotiate an acceptable payment below the provider's billed charges

Responsibilities:

  • Answering calls from providers who are questioning the paid amount on any claim(s) handled by Zelis for payor.
  • Returning all calls within one business day of receiving the call.
  • Address newly assigned work within 48 hours of receipt.
  • Creating payment negotiation documents using proprietary programs and transmitting those via fax, e-mail, or other methods.
  • Documenting stages of process and outcome of post payment negotiation in custom database.
  • Analyzing medical claims and being able to discuss them with specific providers.
  • Negotiating claims/bills as required.
  • Performs other related responsibilities as assigned.

Qualifications:

  • 4-year college degree preferred
  • Three years or more experience in healthcare collections, billing or claim negotiations
  • Demonstrated success in a sales or contract negotiations 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, retail or sales is beneficial.

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.

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