Claims Editing Optimization Project Manager

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