Sr Regulatory Reimbursement 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:

• Research, analyze, and interpret complex regulatory and authoritative sources regarding healthcare reimbursement requirements and synthesize findings into clear, supportable conclusions. Use approved AI-enabled tools and other research methods as appropriate, critically evaluating results against authoritative sources.
• Translate reimbursement requirements and payment calculation logic into clear business and product requirements, user stories, and well-defined acceptance criteria; collaborate with development partners to support accurate implementation.
• Develop test scenarios and claims with expected outcomes to validate reimbursement requirements and implemented payment methodologies.
• Analyze healthcare reimbursement data, including fee schedules, provider files, and rate information, using internal tools and software such as Microsoft Excel.
• Interact with regulators, clients, and internal stakeholders to gather, clarify, and document requirements.
• Support implementations, quality assurance, audits, troubleshooting, and defect correction by investigating issues, evaluating relevant information, and developing supportable conclusions and recommendations.
• Educate internal and client staff regarding healthcare payment systems and procedures and maintain supporting documentation and processes.
• Work with supporting staff to oversee assigned payment systems and understand how requirements and changes affect related processes and system components.
• Proactively identify questions, risks, gaps, dependencies, or unintended impacts and communicate them clearly to team members and leadership.
• Manage competing priorities and deliver accurate, high-quality analysis while meeting established deadlines.
• Perform additional responsibilities as assigned.

What You'll Bring to Zelis:

• Bachelor's degree in healthcare administration, business administration, or a related field, or equivalent relevant experience.
• Five or more years of relevant experience involving healthcare claims processing, reimbursement, payment methodologies, product or business analysis, regulatory research, requirements analysis, or related healthcare analysis. Demonstrated experience researching complex subjects, interpreting requirements, and translating findings into clear, actionable outcomes is strongly preferred. Medicaid experience is a plus but is not required.
• Strong understanding of healthcare claims processing, including institutional and/or professional claims, standard healthcare coding, reimbursement methodologies, and factors that influence claim payment outcomes.
• Strong analytical, critical-thinking, and problem-solving skills, including the ability to work through ambiguous or incomplete information, identify the right questions, evaluate evidence, and draw well-supported conclusions.
• Strong attention to detail with the ability to identify inconsistencies, gaps, risks, and potential downstream impacts.
• Experience gathering and documenting business or product requirements and translating requirements into clear, testable outcomes.
• Experience developing or executing test scenarios and evaluating actual results against expected outcomes.
• Proficiency with Microsoft Excel and similar data analysis tools. Basic understanding of relational data and databases; ability to use or interpret simple SQL queries is a plus.
• Experience using AI-enabled tools to support research, analysis, or knowledge work, with demonstrated ability to critically evaluate results and validate conclusions against authoritative sources.
• Good understanding of public and private healthcare payment systems and related healthcare concepts, including medical claims, standard claim coding, claim editing, and contracting.
• Ability to understand business processes and systems and identify potential risks, gaps, dependencies, or unintended impacts.
• Ability to manage multiple priorities and assigned deliverables with minimal supervision and communicate effectively with technical and non-technical stakeholders.

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.