Manager, Post Pay Claim Settlement

Zelis Healthcare, LLC
401(k), remote work
United States, Missouri, St. Louis
Apr 10, 2025
At Zelis, we Get Stuff Done. So, let's get to it! A Little About Us Zelis is modernizing the healthcare financial experience for all 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. A Little About You You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview The Manager, Post Pay Claim Settlement will be responsible for the leadership and continuous development of the post payment claim settlement team. As the team leader, the Manager will be accountable for exceeding department 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. What you'll do: 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 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. Resolve escalated inquiries from providers, clients and internal teams. Leads the expansion, oversight and performance of the global resources and workflows. Collaborate with and present data trends and expectations with external and internal clients. Partner with leadership to develop and manage flex staffing models to support claim volumes Communicate goals, vision and purpose of team to improve team engagement and align team to expectations What you'll bring to Zelis: Proven leader with the ability to motivate, empower and drive collaboration 7+ years of healthcare claims related experience Demonstrated expertise in claim settlement and advocacy services Bachelor's degree preferred Excellent communication and interpersonal skills Experience leading matrixed and/or global teams preferred Recognize deviations or red flags, escalate issues to senior leaders, and devise and implement solutions. Ability to set & manage and enhance team performance & expectations; coaching & counseling and if not successful, moving forward with formal performance management successfully. 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. Utilize data analytics to forecast inventory trends and balance workloads. Leverage data analytics to identify and implement efficiency improvements. Be able to identify strengths and opportunities to help develop associates in alignment with business need and individual career interests. Ability to pull, analyze, interpret and communicate data effectively down and up through the organization. Domestic travel around 10% 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. Our Values and Culture We are always thinking about life beyond the laptop and how we can drive positive change for our clients, our associates, and our communities. Our IMPACT Value Behaviors are how we elevate that thinking and turn it into action: Drive Innovation Embrace a Growth Mindset Put People First Act With Agility Champion Collaboration Build Trust We look at the big picture when it comes to our associates and our culture. We work to effectively build a thriving, exciting experience for our associates. We leverage these values to continuously evolve an award-winning culture that has a longevity greater than the novelty of a ping pong table in the break room. Our idea of a great workplace is where we can show up as our authentic selves-which is the best way to bring together extraordinary talented people who feel empowered to make a positive IMPACT. A Lot of Respect This is a collaborative organization where everyone is on your team. Each person-from the newest intern to the CEO-is in their position because they are an expert, and they view you with the same lens. No matter who you are, where you sit in the organization, or the span of your tenure, everyone at Zelis is treated with respect. We respect your time (so much so that we aren't asking you to write a cover letter). We make sure you have time to focus by offering Meeting-Free Wednesdays as well as time for you with Zelis Cares Fridays early dismissal. We respect and prioritize work-life balance. With flexible PTO, a hybrid/remote work environment, and a culture that encourages disconnecting after hours, we ensure you have the time and space to manage life's surprises and fully engage outside of work. Working "9 to 5" isn't just a hit song; we respect business hours and promote wellness offerings to keep you at your best, both on and off the clock. We respect diverse opinions. There are always seats at the table, and we're eager to add more chairs. We continue to build our Diversity, Equity, and Inclusion initiatives including training, guest speakers, associate-led Business Resource Groups, in-office DEI events, and more. We respect that everyone has different needs. Zelis has built and continues to add to our benefits offerings by including medical, dental, 401k, fertility and family building, education assistance, pet insurance, menopause and midlife care, and more. We respect YOU. As an Equal Opportunity Employer, we believe that everyone's voice has a place in the chorus. We encourage members of traditionally underrepresented communities to apply. 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 welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. 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. Disclaimer We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.