New

Claims Editing Optimization Project Manager

Zelis Healthcare, LLC
401(k), remote work
United States, New Jersey, Morristown
340 Mount Kemble Avenue (Show on map)
Apr 01, 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: As part of the Price Optimization division, this role is responsible for the successful execution of the Clients experience during implementations in an effort to increase the client's acceptance rate of edits as the Subject Matter Expert in customization to increase savings and align with the Clients policies. What you will do: Independently prioritize projects and assignments. Attend Client facing and Internal Claims Editing Implementation meetings, summarize takeaways and follow-up as needed with the appropriate team. Design, update and maintain Decision Matrices both internal and external versions. Consult and strategize with Clients on system capabilities for Customizations/Client Specific Edits. Use independent judgement with respect to Customizations/Client Specific Edits/Client Edit package setup. Develop and provide project plans for Clients Edit Packages. Develop and manage project plans tied to operational initiatives. Create technical requirements for Client Specific Edits. Document and discuss Client's decisions. Continuous improvement and refinement to the implementation edit configuration processes Attend internal Edit release meetings and provide any technical or configurable parameters to the team. Identify risks and communicates risks to Leadership. Mitigate any risks to the project. Develops actionable steps to improve processes Creating and maintaining SOP's and Job Aides for the team. Collaborate with cross-functional teams Maintain relationships with cross-functional teams and Senior Leadership. Host/Attend internal Steering Committee meetings. Performs touch-point meetings with the Analyst for status on Projects As the subject matter expert provide feedback to the Analyst Assist with Clients steady state Performs other duties as required. Must be available to travel 5-10% as required to meet business needs. What you'll bring to Zelis: Holds a Bachelor's degree or +10 yrs overall equivalent experience. Scrum Master Certification preferred In-Depth knowledge of prioritization and management of multiple concurrent projects. Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships. Experience managing projects and process innovative changes effectively. Strong working knowledge of MS Excel, computer systems, applications and operating systems. Demonstrated a growth mindset and motivation skills, a self-starter with an ability to research and resolve issues Excellent skills in critical thinking and analysis, project management, meeting facilitation, and interpersonal interactions Experience in the healthcare field is preferred 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.