Position Overview:
The Manager, Out of Network Post Pay Solutions will be responsible for the leadership and continuous development of the ONN post pay team. As the team leader, the Manager will be accountable for exceeding departmental business objectives to drive best in class claim settlement while collaborating with cross functional partners to support our Out of network and Reference Based Pricing products.
Essential Duties and Functions:
Manage people, process and technology required to deliver leading customer experience related to post payment claim settlement for clients, providers, and members.
Drive initiatives and recommendations for inquiry/case management and resolution process and system improvements to optimize accuracy and efficiency.
Establish key performance indicators and coach employees toward performance and development objectives.
Manage operations by monitoring system performance; identifying and resolving problems; preparing and completing action plans; completing system audits and analyses; managing quality assurance programs.
Manage staffing levels and team structure to optimize performance, including planning, assigning, and directing work.
Manage daily workflow and inventory volumes to allocate resources to cover inventory as appropriate.
Resolve escalated inquiries from providers, clients and internal teams.
Leads the expansion, oversight and performance of the global resources and workflows.
Collaborates with and presents data trends and expectations with internal and external stakeholders.
Partner with leadership to develop and manage flexible staffing models to support claim volumes
Other duties as assigned
Experience, Qualifications, Knowledge and Skills:
Proven leader with the ability to motivate, empower and drive collaboration
7+ years of healthcare claims and/or provider dispute related experience
Experience with NSA and/or IDR claims preferred
Demonstrated expertise in claim settlement and advocacy services
Excellent communication and interpersonal skills
Bachelor’s degree preferred
Experience leading matrixed and/or global teams preferred
Willingness and ability to travel: Primarily domestic travel, up to 10%.
Problem-solving skills: Recognize deviations or red flags, escalate issues to senior leaders, and devise and implement solutions.
Effective performance management: Ability to set, manage and enhance team performance & expectations; coaching & counseling and if not successful, moving forward with formal performance management successfully.
Strong communication skills: Must be able to communicate effectively with team, in public and in client settings. Communicate progress, needs and updates to direct management timely and effectively.
Results-driven mindset:
Proactive inventory management: Utilize data analytics to forecast inventory trends and balance workloads.
Process improvement: Leverage data analytics to identify and implement efficiency improvements.
Associate development: able to identify strengths and opportunities to help develop associates in alignment with business need and individual career interests.
Data & reporting: able to pull, analyze, interpret and communicate data effectively down and up through the organization.
Instilling Vision & Purpose: able to communicate goals, vision and purpose of team to improve team engagement and align team to expectations
Location and Workplace Flexibility:
We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.
Zelis is modernizing the healthcare financial experience 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 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.
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 qualified 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.
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