Director of Out of Network Claims Negotiations

4 weeks ago


Bedminster, Pennsylvania, United States Zelis Healthcare Full time

Job Summary:

The Director of Out of Network Claims Negotiations is responsible for overseeing the daily operations of the Out of Network Negotiation department. This includes managing staff and ensuring production quality meets or exceeds defined Key Performance Indicators (KPIs).

Key Responsibilities:

  • Ownership of all aspects of performance, training, coaching, team structure and scalability, and career pathing as it relates to all managers and associates within the OON Negotiations department.
  • Identify and implement strategic initiatives to drive savings and revenue with a focus on all areas of OON product but a primary focus on Negotiations and Choice Agreements.
  • Identify and implement process and system enhancements including but not limited to the Negotiation SOP's, Negotiations UI, Auto-distribution, and Auto-fax to drive efficiency and savings within the negotiation teams.
  • Achieve or surpass monthly and annual revenue targets within Negotiations and OON product as a whole.
  • Collaborate with Product and others as needed to implement product initiatives to drive savings and revenue for the OON product.
  • Build and Monitor Negotiation KPI's to ensure product performance to furthermore investigate both positive and negative trends such as volume, hit rate, savings rate, & Choice agreements.
  • Partner with UAT team on deployment work that may impact Negotiations.
  • Partner with Auditing to identify key alerts to drive Quality Assurance within Negotiations.
  • Mentor and coach management within the Out of Network (OON) Negotiations team.
  • Collaborate with leadership and People & Culture on performance management matters.
  • Address escalated client issues, such as provider disputes and special requests.
  • Support associates in troubleshooting system-related challenges.
  • Partner with the Provider Services Department to address provider issues, including contract and discount disputes.
  • Analyze negotiation product trends to provide initiatives to drive further savings/revenue and efficiencies.
  • Collaborate cross-departmentally to achieve results as intended.
  • Maintain awareness of and ensure adherence to Zelis standards regarding privacy.
  • Must be available to travel 10% - 20% as required to meet business needs.

Requirements:

  • Bachelor's degree or historical equivalent experience.
  • 10+ years of experience in claims processing.
  • 5+ years of experience managing a team of 20+ within Claims Operations.
  • Proven expertise in processing and negotiating all Out of Network claims.
  • A self-starter with an ability to research and resolve issues.
  • Strategic mindset with ability to identify and implement new ideas.
  • Management of strategic operational and technology initiatives. Experience managing projects and process innovative changes effectively.
  • Strong working knowledge of MS Excel, computer systems, applications and operating systems.
  • Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships.
  • Excellent skills in critical thinking and analysis, project management, meeting facilitation, and interpersonal interactions (e.g., partnering, conflict management, consulting, etc.).
  • Ability to create and document workflow processes.

Location and Workplace Flexibility:

Zelis is a modern healthcare financial experience company that provides a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. We foster a hybrid and remote-friendly culture and all of our employee's work locations are based on the needs of the position and determined by the Leadership team.

Zelis is proud to be an equal opportunity employer. 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.

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 .

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.



  • Bedminster, Pennsylvania, United States Zelis Healthcare Full time

    Job Summary:The Director of Out of Network Claims Negotiations is responsible for overseeing the daily operations of the Out of Network Negotiation department. This includes managing staff and ensuring production quality meets or exceeds defined Key Performance Indicators (KPIs).Key Responsibilities:• Ownership of all aspects of performance, training,...


  • Bedminster, Pennsylvania, United States Collabera Full time

    Job Title: Telecommunications Equipment SpecialistJob Summary:Collabera is seeking a highly skilled Telecommunications Equipment Specialist to join our team. The ideal candidate will have a strong background in telecommunications, with experience in equipment engineering, field operations, and project management.Key Responsibilities:• Design, implement,...

  • Network Engineer III

    3 months ago


    Bedminster, United States The Judge Group Full time

    Role: Network Engineer III Location: Bedminster, NJ (Remote) Job Type: Contract JOB DUTIES: The successful candidate will join the Core Network Engineering and Implementation team with responsibilities for engineering client's new eNSE platform located within datacenters throughout the United States. Being a part of the Network Build Team, you will assist...

  • Network Engineer III

    1 month ago


    Bedminster, United States The Judge Group Full time

    Role: Network Engineer III Location: Bedminster, NJ (Remote) Job Type: Contract JOB DUTIES: The successful candidate will join the Core Network Engineering and Implementation team with responsibilities for engineering client's new eNSE platform located within datacenters throughout the United States. Being a part of the Network Build Team, you will assist...


  • Bedminster, United States Crossroads4Hope, A Network of Cancer Support Full time

    Crossroads4Hope, A Network of Cancer Support, has been improving the lives of people with cancer and their loved ones for more than two decades. We take on the cancer journey with people diagnosed, caregivers, and loved ones, providing a network of support, information, resources, and professionals who fill critical gaps in care that often occur between...

  • Clinical Director

    1 week ago


    Bedminster, United States JAG Physical Therapy Full time

    Clinical DirectorThe Physical Therapist Clinical Director is responsible for complete oversight of operations and administration of rehabilitative outpatient clinic providing Physical and Occupational Therapy. Ensures compliance with all regulations and health care requirements. This position is also responsible for patient evaluation and treatment. Who We...


  • Bedminster, United States TBG | The Bachrach Group Full time

    I am representing a nonprofit corporation that acts as a consortium manager from the US government. Their goal is to speed up the deployment of technology to the nation and warfighter, while also reducing the government's procurement costs. They are seeking someone with at least ten years of contracts experience.Responsibilities:Draft, review and negotiate...


  • Bedminster, New Jersey, United States Bank of America Full time

    Merrill Financial Solutions AdvisorMerrill Wealth Management is a leading provider of comprehensive wealth management and investment products and services for individuals, companies, and institutions. Our team of experienced financial advisors and wealth management professionals work closely with clients to understand their unique financial goals and develop...


  • Bedminster, United States The Judge Group Full time

    Role: Equipment Engineer III Location: Bedminster, NJ (Hybrid) Job Type: Contract This position of Engr III Spec-Ntwk Equipment is responsible for small cell, macro cell, and/or 5G equipment engineering. The ideal candidate will have experience in ordering equipment, managing equipment schedules, vendor management, and overall project...


  • Bedminster, United States The Judge Group Full time

    Role: Equipment Engineer III Location: Bedminster, NJ (Hybrid) Job Type: Contract This position of Engr III Spec-Ntwk Equipment is responsible for small cell, macro cell, and/or 5G equipment engineering. The ideal candidate will have experience in ordering equipment, managing equipment schedules, vendor management, and overall project...


  • Bedminster, United States TBG | The Bachrach Group Full time

    Our client, a nonprofit corporation manages consortia for the government. Their mission is to accelerate the deployment of technologies to the military and the nation, while also reducing government procurement costs.As Associate General Counsel, you will play a vital role by providing expert legal advice and strategic guidance to the Vice President &...


  • Bedminster, United States TBG | The Bachrach Group Full time

    Our client, a nonprofit corporation manages consortia for the government. Their mission is to accelerate the deployment of technologies to the military and the nation, while also reducing government procurement costs.As Associate General Counsel, you will play a vital role by providing expert legal advice and strategic guidance to the Vice President &...

  • Project Manager

    3 weeks ago


    Bedminster, United States NextGen | GTA: A Kelly Telecom Company Full time

    They will be responsible for small cell, macro cell, and/or 5G equipment engineering. The ideal candidate will have experience in ordering equipment, managing equipment schedules, vendor management, and overall project management.This person will do a lot of Project Management work, tracking dates and timelines to ensure equipment comes in on time and...


  • Bedminster, United States Alfasigma USA Full time

    Are you passionate about driving growth and building strategic partnerships? We are looking for a dynamic and results-oriented Business Development Manager to join our Contract Development and Manufacturing Organization team. If you have a proven track record in business development within the CDMO sectors, and you're ready to take your career to the next...

  • Toddler Educator

    1 month ago


    Bedminster, New Jersey, United States Primrose School of Bedminster Full time

    Job OverviewAt Primrose School of Bedminster, we're dedicated to providing a nurturing environment for young children to grow and thrive. As a Toddler Teacher, you'll play a vital role in shaping the minds of our future leaders.Key ResponsibilitiesDesign and implement engaging lesson plans that cater to the unique needs of each child.Build strong...

  • Toddler Teacher

    2 weeks ago


    Bedminster, United States Primrose School of Bedminster Full time

    Benefits: Competitive salary Employee discounts Free uniforms Paid time off Training & development Tuition assistance Build a brighter future for all children. Teaching is more than a job. It’s an opportunity to foster curiosity, creativity and compassion in children—all while helping them develop a lifelong love of learning. As a Toddler Teacher at...


  • Bedminster, United States NextGen | GTA: A Kelly Telecom Company Full time

    RF Optimization III/IVRemote from USATMO + Nokia highly preferred 5g hands on experience is MUST What do you need to bring on table as RF Optimization Engineer:-Minimum of 10 years of work experience in RF Optimization for LTE, VoLTE, and 5G technologies.5G Experience: Minimum of 2 years working with 5G technologies.Drive Test-based Optimization...


  • Bedminster, United States IntelyCare Full time

    Make an hourly rate of up to $34 as a Certified Nursing Assistant (CNA) in Basking Ridge, NJ (and the surrounding area), while working as a W2 employee with complete control over when, where, and how often you work. That's right, at IntelyCare you get to pick the shifts at our partnering facilities that work best for you, with the freedom to take time off on...

  • Legal Clerk

    3 weeks ago


    Bedminster, United States APR Consulting Full time

    Our client is a worldwide telecommunications company that offers voice, data and video services and solutions on its award-winning networks and platforms, delivering on customers’ demand for mobility, reliable network connectivity, security and control.We are looking for a Legal Clerk to perform data entry of legal process into the workflow management...


  • Bedminster, United States Peapack-Gladstone Bank Full time

    Peapack-Gladstone Bank is a well-recognized, high-performing boutique bank; a leader in wealth, lending and deposit solutions, capable of providing the most sought-after products and services that fulfill all of our clients' needs. We offer an innovative approach to private banking to help clients establish, maintain and expand their legacy.What makes...


  • Bedminster, United States Peapack-Gladstone Bank Full time

    Peapack-Gladstone Bank is a well-recognized, high-performing boutique bank; a leader in wealth, lending and deposit solutions, capable of providing the most sought-after products and services that fulfill all of our clients' needs. We offer an innovative approach to private banking to help clients establish, maintain and expand their legacy. What makes...

  • Project Manager

    2 weeks ago


    Bedminster, NJ, United States NextGen | GTA: A Kelly Telecom Company Full time

    They will be responsible for small cell, macro cell, and/or 5G equipment engineering. The ideal candidate will have experience in ordering equipment, managing equipment schedules, vendor management, and overall project management.This person will do a lot of Project Management work, tracking dates and timelines to ensure equipment comes in on time and...