Senior Solution Advisor, Payment Integrity

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:

* Become a recognized Subject Matter Expert on all facets of the Payment Integrity portfolio (encompassing Expert Claims Review and Claims Editing) and its design, configuration, implementation, and utilization.

* Partner with Sales team to identify client business and product requirements during the sales cycle and determine recommended solutions and value proposition to win business.

* Collaborate and support the Client Management team on client meetings and with client, facility, and provider questions/concerns.

* Assist Sales and Client Management teams with identifying new sales and up/cross-sell areas of opportunity. Assist with organization and prioritization of sales pipelines.

* Provide expertise on Payment Integrity portfolio, including PowerPoint creation and presentation, data analyses, evaluating product fit, and answering client/prospect questions.

* Strategic partner with the Data Insights team, providing Payment Integrity product and performance expertise and data analysis to ensure metrics/reports accurately represent the product.

* Responsible for client/prospect proposal responses and proposal content updates.

* Serve as a strategic member of the product roll-out implementation team.

* Participate in and/or lead training regularly on product and operational subject matter, such as emerging technology, new products, custom solutions, etc.

* Partner with Price Optimization and Marketing internal stakeholders to maintain current product knowledge, identify collateral improvements/needs, discuss specific client/prospect needs, etc.

* Provide market & product intelligence to management and participate in the development of future solution strategies.

* Attend, absorb, and utilize training to learn about emerging technology, new products, custom solutions, etc. and stay informed about market trends in the Payment Integrity space via Zelis competitive intelligence information and self-learning from online resources.

* Engage in work activities with intellectual curiosity, flexibility, and an elevated level of proactiveness.

* Perform cross-coverage duties across the Payment Integrity portfolio as needed.

* Other projects and initiatives as designated by manager in support of Sales and the Payment Integrity portfolio as a whole or the appropriate components.

What You'll Bring to Zelis:

* Prior experience in healthcare Payment Integrity/Case Management required (ex., clinical and coding bill review/audits, utilization review/management, prior authorizations, disputes/appeals).

* Coding experience a plus.

* Demonstrated success evaluating data and making recommendations on healthcare utilization, trends, and overall healthcare claim experience.

* Previous client-facing experience and an ability to answer complex (data) questions.

* Prior direct sales or consultative pre-sales experience preferred.

* Prior sales and/or implementation experience working with healthcare payers and technology-enabled solutions preferred.

* Superior communication and organizational skills, ability to manage multiple concurrent deadlines, and exceptional attention to detail.

* Strong project management skill sets.

* Proficient/expert experience level across MS suite.

EDUCATION / LICENSURE:

* College degree required.

* Licensed Professional Nurse (LPN) or Registered Nurse (RN) required.

* Certified Coder or open to obtaining a coding certification preferred.

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.