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Regulated Claims Settlement Coordinator
3 months ago
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. Responsibilities Prepares and presents Zelis’ response packages to cases submitted for arbitrations at both the state and federal level under the NSA. Provides input and guidance on the selection process for certified arbitration entities under the NSA. Creates a scalable IDR defense package through improved automation in the creation and compilation of the necessary data elements. Responds to Notice of offer requests using proprietary programs to calculate an offer. Drafts brief to provide analysis dispute along with objections to support client positions in arbitration packages pursuant to federal regulations. Ensures Claims Settlement processes deliver required information for arbitration reviews and position Zelis for optimal success. Documents stages of IDR process and outcomes within internal database and maintain an accurate record. Communicates with IDRE’s, Clients and Providers as needed to request or provide additional information. Provides monthly performance reporting to departmental leadership. Maintains 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. Education Bachelor's Degree preferred. Skills 3-5 years of claims experience in a healthcare environment. Company Overview 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 ask 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. #J-18808-Ljbffr
