Location: Convent Station,NJ, USA
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.
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
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 ...@zelis.com.
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