Client Inquiry 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.

  

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 Client Inquiry Analyst is responsible for the resolution of inquiries for all assigned Zelis editing clients. The Client Inquiry Analyst will act a subject matter expert (SME) as it pertains to correct coding/claim adjudication guidelines and the Zelis editing product. The Client Inquiry Analyst will provide written responses to all client inquiries adhering to all key performance components to achieve goals and results for the Zelis Claims Cost Solutions department. The Client Inquiry Analyst will support the day-to-day activities of assigned team ensuring it aligns with the overall mission and adherence to best practice policies as defined by the organization. This role is responsible for ongoing support of our products and services for our clients. This role involves analyzing client data, identifying trends, and providing actionable insights to improve client satisfaction and retention. The Analyst will work closely with cross-functional teams to deliver exceptional client experiences and drive continuous improvement.

What you’ll do:

• Perform as subject matter expert (SME) to provide coding and claim adjudication guidance for all assigned clients.

• Demonstrate an expert level of understanding of the Zelis editing products with an ability to clearly articulate correct coding and claim adjudication guidelines.

• Demonstrate the ability to provide written responses that provides clarity and guidance to all internal and external client inquiries.

• Effectively utilize all tools and applications for the resolution and escalation of all internal/external edit/claim inquiries.

• Manage day-to-day activities to ensure all inquiries received are responded to and resolved within appropriate timeframes per specified Service Level Agreements (SLAs)

• Actively participate in all external/internal client meetings by providing an overview of identified inquiry or edit trends for assigned clients

• Proactively identify, resolve and escalate client issues while effectively partnering with assigned business partners to maintain strong internal and external relationships

• Effectively analyze data to ensure proactive identification, escalation and resolution of client issues • Effectively prioritize to deliver on-time completion of all tasks assigned

• Ensure compliance with HIPAA regulations and requirements.

• Build and maintain strong, long-lasting relationships with other teams through regular communication and proactive engagement.

• Analyze client data to identify trends, patterns, and areas for improvement.

• Develop and deliver insightful reports and presentations to clients, highlighting key findings and recommendations.

• Monitor client performance metrics and provide actionable insights to drive client success.

• Collaborate with cross-functional teams to identify and implement process improvements that enhance the client experience.

• Gather and analyze client feedback to inform product development and service enhancements.

• Stay up-to-date with industry trends and best practices to ensure our client success strategies remain competitive and effective.

What you’ll bring to Zelis:

• Bachelor’s degree in Business, Healthcare, Data Analytics, or a related field. Or equivalent experience.

• 3+ years of relevant education and work experience with hea