Medical Claims Documentation Specialist

Zelis Healthcare, LLC; Morristown (NJ); Hybrid; USD 42,981,000 - 54,443,000; Full time

Benefits offered by this job

401k plan with employer match

Flexible paid time off

Holidays

Parental leaves

Life and disability insurance

Health benefits including medical, and

Job summary

Zelis Healthcare, LLC is seeking a Document Retrieval Specialist to support medical claim review and audit processes. You will proactively contact providers to request, obtain, and manage billing documentation to ensure timely, accurate claim evaluation.

You will upload documents, verify completeness, and maintain organized records while meeting productivity and quality standards. A HS diploma is required; Associate's degree is a plus, with preferred healthcare claims or customer service

Qualifications

• High School Diploma (Associate's degree a plus).
• Experience in healthcare, medical claims, billing, or customer service preferred.
• Proficient with Microsoft Office and web-based systems.
• Strong prioritizing and organizational skills; excellent customer service and phone etiquette.

Responsibilities

• Assist nursing staff in the medical claim audit process by contacting healthcare providers to request and obtain billing documents via fax, mail, and email for claims processing.
• Receive and upload retrieved documents into designated systems, ensuring documents are properly indexed and associated with the correct claim.
• Review uploaded documentation for completeness, accuracy, and compliance with client and provider requirements, identifying and escalating discrepancies as appropriate.
• Organize and prioritise assigned claims daily and conduct timely follow-up on outstanding document requests.
• Accurately document outreach attempts, provider communications, request statuses, and other relevant information.
• Utilize document retrieval systems and related tools efficiently.
• Learn and process requests according to applicable provider and client requirements.
• Meet or exceed the Document Retrieval Performance Standards established by the Document Retrieval department.
• Maintain awareness of and adherence to Zelis standards regarding privacy and confidentiality.

Skills

Healthcare claims experience

Customer service

Microsoft Office

Organizational skills

Education

High School Diploma

Associate's degree a plus

Job description

Zelis Healthcare, LLC is seeking a Document Retrieval Specialist to support medical claim review and audit processes. You will proactively contact providers to request, obtain, and manage billing documentation to ensure timely, accurate claim evaluation.

You will upload documents, verify completeness, and maintain organized records while meeting productivity and quality standards. A HS diploma is required; Associate's degree is a plus, with preferred healthcare claims or customer service