Position Overview

The Claims Settlement Specialist supports claim settlement with providers through post payment negotiation. The Claims Settlement Specialist will be responsible for handling provider telephone calls regarding the payment amount paid to a provider by a payor based on Zelis data points.

During this call, the Claims Settlement Specialist must understand : (1) the procedures billed on the claim / bill; (2) the estimate of the fair value of the payment that was remitted to the provider based on Medicare pricing, location / facility / provider comparisons, and Zelis’ proprietary evaluation software;

3) identify negotiation points for that particular provider if payment is not accepted, as is; and, when required, negotiate an acceptable payment below the provider’s billed charges

Responsibilities :

Answering calls from providers who are questioning the paid amount on any claim(s) handled by Zelis for payor.

Returning all calls within one business day of receiving the call.

Address newly assigned work within 48 hours of receipt.

Creating payment negotiation documents using proprietary programs and transmitting those via fax, e-mail, or other methods.

Documenting stages of process and outcome of post payment negotiation in custom database.

Analyzing medical claims and being able to discuss them with specific providers.

Negotiating claims / bills as required.

Performs other related responsibilities as assigned.

Qualifications :

4-year college degree preferred

Demonstrated success in a sales or contract negotiations setting

Knowledge of the full Microsoft Office Suite of products to include, but not limited to, MS Outlook, MS Word, MS Excel, and MS PowerPoint

A background in healthcare collections, provider billing, retail or sales is beneficial.

Last updated : 2024-06-19