Operations Analyst

At Zelis, we Get Stuff Done. So, let’s get to it! A Little About Us Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients. At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture. 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 Operations Analyst will provide daily operational support to the Itemized Bill Review team, including the itemized bill review, clinical chart review, and document retrieval teams. Responsibilities include reporting, claims management, analysis, client savings identification, digitized records QA, and in-depth knowledge of client contractual parameters. Key responsibilities: Manage the screening and distribution processes of Itemized Bill Review claims and support the end-to-end workflow audit for Zelis Prepay and Post-pay Programs. Assist with training and onboarding of new team members. Monitor new client claims post-implementation to ensure high performance per client requirements. Thoroughly understand all IBR clients, business processes, inventory management, file processes, and financial recovery tracking. Accountable for the deployment of resources for the management of daily claims screening, distribution, and referral processes, including IBR and IBR-EDI, DRG validation, IBR Distribution, and support for Out-of-Network report management. Responsible for the set up and processing of dual acceptance claims, as well as the creation and accuracy of client facing documentation. Accountable for ensuring all IBR claims are managed per client requirements. Maintain awareness of and ensure adherence to Zelis standards regarding privacy. Assist other Zelis staff members as needed, and as requested. JOB REQUIREMENTS: Technical Skills / Knowledge: Demonstrates a solid understanding of screening and audit techniques for identifying revenue opportunities. Proficiency in training techniques aimed at conveying subject matter expertise and scaling staff to maximize savings and revenue. Computer proficiency and technical aptitude with the ability to utilize CMS and MS Office Suite. Development and adherence to department SOP’s. Thorough knowledge of company and departmental policies and procedures. Act as subject matter experts to various departments Independence/ Accountability: Maintain personal and department production and financial goals. Requires minimal daily supervision. Ability to make decisions based on established guidelines and gained knowledge of HBR departments and client standards. Regularly reviews goals and objectives with the supervisor. Ability to follow detailed instructions on new assignments. Accountable to day-to-day tasks. Must be professional and respect the confidentiality of administrative matters and files. Ability to manage and prioritize multiple tasks. Ability to work under pressure and meet deadlines. Problem Solving: Makes logical suggestions for likely causes of problems and independently recommends solutions. Excellent organizational skills are required to prioritize responsibilities, thus completing work promptly. Outstanding ability to multi-task as required. Outstanding ability to make clear decisive decisions. Attention to detail and concern for impact is essential. Excellent project management skills. Leadership Activities: Guides lower-level personnel. Regularly attends meetings and contributes to training sessions. Must be proactive to ensure proper follow-up and completion of projects. Must maintain a professional demeanor in sensitive situations. Assists other departments when necessary. Communication Skills: Must work well with others. Effectively communicate with others by giving and receiving feedback. Communicates ideas and information clearly. Must have excellent communication and presentation skills to interface with internal and external HBR departments effectively. Professional experience: High School Diploma required. Associate’s degree preferred. 2+ years of experience within the healthcare industry preferred. Experience with health/medical insurance and processing of claims. Solid written & verbal communication skills. Strong prioritizing & organizational skills. Excellent typing/data entry skills. Strong working knowledge of Microsoft Office suite as well as Adobe Acrobat. Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future. Location and Workplace Flexibility Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-office work and activities vary based on work and team objectives in accordance with Company policies. While location expectations vary by role, candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in-office presence is guided by team and business needs rather than a fixed weekly schedule. Base Salary Range $19.00 - $24.00 At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role. Zelis’ full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees’ health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage. 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 View email address on click.appcast.io. Disclaimer 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. Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients. Zelis maintains a transparent, fee-free recruitment process. All genuine offers originate from our Talent Acquisition team using the “@zelis.com” domain. We do not use WhatsApp or personal emails for recruitment. Forward any suspected fraud to View email address on click.appcast.io for prompt investigation. Thank you for staying vigilant.