Claims Support Specialist

Position Overview:

The Claims Support Specialist position provides comprehensive administrative support as a part of the Client Experience. The Claims Support Specialist has responsibilities which include phone calls from members or providers as well as providing support to departments within Zelis Enterprise.

Key Responsibilities:

• Review and process correspondence from providers, members, and payors according to standard operating procedures.

• Manage various systems and databases.

• Provide daily updates to management and clients as needed.

• Manage communication via email and Microsoft Teams.

• Confirms that all documentation processes adhere to Zelis standards regarding privacy, compliance, legal aspects, and HIPAA standards.

• Maintain production standards according to department guidelines.

• Performs other related responsibilities as assigned.

Professional Experience:

• 1+ years of medical claim payment review.

• Adhere to established HIPAA, compliance, and security policies. · Maintain a keen awareness of and ensure strict adherence to Zelis standards concerning privacy and confidentiality.

• A background in healthcare, health insurance, healthcare compliance, medical billing, negotiations, or state and federal regulated claims.

Education:

• Bachelor's degree or equivalent experience in a healthcare setting.
• A minimum of 2 years of experience in a medical field or healthcare environment. Familiar with the lifecycle of medical claims, including reviewing explanations of benefits/payments.

Technical Skills:

• Proficient in Microsoft products (Word, Excel, PowerPoint, and Outlook), Smartsheet, and adaptable to various industry software programs.

• Working knowledge of general office equipment.

Independence/ Accountability:

• Receive comprehensive instructions for assignments and seeks guidance to determine subsequent actions.

• Ability to follow detailed instructions and carry through.

• Exhibit proficiency in pertinent job responsibilities, enabling a gradual increase in autonomy.

• Maintain a professional demeanor and strictly upholds the confidentiality of administrative matters and files.

• Demonstrate adeptness in managing and prioritizing multiple tasks.

• Thrive under pressure and consistently meet deadlines.

• Regularly review goals and objectives with the supervisor.

Problem Solving:

• Tackles complex assignments that demand sound judgment and proactive problem-solving.

• Strong organizational skills needed to prioritize responsibilities and effectively complete work

• Exhibits exceptional task management capabilities, efficiently handling multiple tasks as needed.

• Meticulous attention to detail and a focus on the impact of actions are crucial attributes.

• Recognizes deviations from experienced observations.

• Completes work in a timely fashion in accordance with departmental deadlines. Alerts leadership in advance if deadlines are unable to be achieved.

Work Environment:

• Travel requirements to (primarily) domestic destinations should not exceed 5%.

• A standard work week exists but with the understanding that additional time/effort outside of the usual parameters can/will occur based upon the overall needs of the integration, where deadlines exist and when necessary due to the needs of the integration team.

• A standard business environment exists with moderate noise levels.

• Ability to lift and move approximately thirty (30) pounds on a non-routine basis.

• Ability to sit for extended periods.

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.