Sr. Manager, NSA Claims Settlement

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 Senior Manager, NSA Claims Settlement is responsible for the comprehensive oversight of operational workflows, people leadership, and the functional strategy for the Open Negotiations process consisting of No Surprises Act (NSA) claims. This role provides strategic and operational leadership to ensure regulatory compliance, operational excellence, and high-quality client outcomes.

The Senior Manager serves as a subject matter expert for NSA operations, leads cross-functional collaboration, drives continuous process improvement, and uses data-driven insights to forecast staffing needs, optimize performance, and resolve complex Legal, Compliance, Product, and Client Leadership issues. This role also provides consultative support to clients and partners while delivering actionable insights to executive leadership and serves as a key contributor to broader NSA program strategy and execution.

What You’ll Do:

• Sets direction and oversees Open Negotiations operational workflows and processes, ensuring timely, compliant, and high-quality delivery aligned with client and organizational objectives. 

• Design, implement, and maintain policies and procedures for Open Negotiations operations; ensure consistent execution and adherence across teams. 

• Serve as a subject matter expert (SME) for NSA regulations and processes, providing guidance to clients and internal stakeholders to ensure compliance. 

• Lead and mentor team members through training, coaching, development, and performance management; must establish clear development objectives and accountability while fostering a collaborative team culture 

• Establish, monitor, and report on key performance indicators (KPIs), ensuring quality assurance programs are in place to support operational excellence. 

• Collaborate cross-functionally with internal partners including but not limited to Claims Management teams, Intake, IDR, and Client management to escalate, troubleshoot, and resolve operational, client, and system-related issues efficiently. 

• Identify process improvement opportunities and partner with Product Owners and stakeholders to enhance technology solutions supporting NSA claims. 

• Manage daily operations by monitoring system performance, resolving issues, implementing corrective action plans, and maintaining quality standards. 

• Resolve escalated inquiries from providers, clients, and internal teams, ensuring timely and effective outcomes. 

• Leads functional operating plans for Open Negotiations, including capacity models, staffing strategies, workforce planning, resourcing recommendations and productivity assumptions aligned to NSA volume forecasts in partnership with senior leadership. 

• Prepare and deliver operational reports, performance insights, and strategic recommendations for clients and executive leadership. 

• Assess regulatory changes and business growth scenarios to proactively adjust operating models and team structures. 

• Lead and participate in cross-functional projects and initiatives as assigned. 

What You’ll Bring to Zelis:

• 8+ years of progressive experience in healthcare claims and/or operations, or regulatory programs.