Expert Claims Review Business 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

What you'll do:

• Participate in relevant ceremonies: Daily Stand-Ups, Backlog Grooming, Sprint Planning, Sprint Review, Sprint Retrospective.
• Leverage AI through all aspects of the role to facilitate user stories and requirements, acceptance criteria or any other aspect of their role
• Assist with the elaboration of the user stories and requirements, supporting team members with their work where required
• Be responsible for providing multi-disciplinary teams with user stories and coaching to define the business-driven acceptance criteria and test cases. Proactively support the uplift of Agile or Kanban practices and foster a culture of continual service improvement
• Consult with the business and product owners to prioritize and shape the product backlog, using Agile or Kanban practices for prioritization around business value
• Define, implement, and maintain business processes and procedures to meet business objectives. Analyze and identify opportunities for business process improvements.
• Collaborate with Solution Owners and/or Product Managers when defining product release content and timeline, applying product development principles, innovative thinking and a focus around the customer or user experience
• Critically evaluate information gathered from multiple sources, reconcile conflicts, and decompose high-level information into details.
• Create and maintain workflows, approval processes, and validation rules based on internal stakeholder requirements.
• Create training materials and documentation for internal and/or external applications.
• Perform a thorough gap analysis of existing to potential functionality for internal and/or external applications.
• Create Release Notes as determined by Product Owner.
• Perform analysis and identify gaps in functionality for system integrations.
• Collaborate with the Scrum team to establish the technical vision and analyze tradeoffs between usability and performance needs.
• Improves systems by studying current practices, designing modifications.
• Assist in Quality Assurance (QA) and/or User Acceptance Testing (UAT) of new software or enhancements to existing software as needed.
• The ability to multi-task and work on multiple assignments will be required.

What you'll bring to Zelis:

• Bachelor's Degree
• 4+ years of experience with Business Analysis and/or Business Process Engineering
• Disciplined, structured and logical approach to problem solving
• Experience in Healthcare industry preferred
• Knowledge of Payment Integrity solutions (hospital billing, claims editing, reimbursement methodologies and acceptable billing practices) preferred
• Knowledge of payer reimbursement policies, state and federal regulations and applicable industry standards preferred
• SQL experience preferred
• Ability to learn a new business and translate these needs into new products, and perform high-level troubleshooting functionality
• Solid troubleshooting, analytical, and business process development skills
• Clear and concise communication both verbally and in writing.
• Preferred - SAFe POPM, Agilist, Teams, or Leading Safe certification

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

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 TalentAcquisition@zelis.com.

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.