Senior Manager, Claims Strategy & Operations

Zelis Healthcare, LLC; Morris Township (NJ); Hybrid; USD 95,000 - 121,000; Full time

Job summary

Zelis Healthcare, LLC is actively seeking a senior leader to oversee multiple teams in the claims negotiation function. The role focuses on operational excellence, strategic initiatives, and strict compliance across claims processes, partnering with leadership to set goals and drive improvement.

You will manage high-value negotiations, monitor metrics, and guide policy development while mentoring staff to achieve high performance and customer satisfaction.

Qualifications

• Typically has a Bachelor's degree with 12+ years of experience; a Master's adds 8+ years.
• Requires proficiency using AI tools skillfully with prompt/agent development ability.
• Experience leading multiple teams or large-scale projects.
• Strong strategic thinking and execution capabilities.

Responsibilities

• Lead and manage multiple teams of negotiators, ensuring alignment with organizational objectives.
• Develop and implement departmental strategies to optimize claims resolution outcomes.
• Oversee high-value and complex claims negotiations, providing guidance and approval as needed.
• Monitor performance metrics and drive continuous improvement initiatives.
• Collaborate with senior leadership to establish policies, procedures, and best practices.
• Analyze claims data to identify trends and recommend strategic improvements.
• Build and maintain strong relationships with internal and external stakeholders.
• Ensure compliance with regulatory requirements and company standards.
• Provide training, support, and development opportunities to team members to ensure high performance and engagement.
• Conduct regular performance reviews, provide feedback, and identify opportunities for professional development.

Skills

AI tools proficiency

Leadership experience

Strategic thinking

Cross-functional influence

Coaching skills

Education

Bachelor's degree

Master's degree

Job description

Zelis Healthcare, LLC is actively seeking a senior leader to oversee multiple teams in the claims negotiation function. The role focuses on operational excellence, strategic initiatives, and strict compliance across claims processes, partnering with leadership to set goals and drive improvement.

You will manage high-value negotiations, monitor metrics, and guide policy development while mentoring staff to achieve high performance and customer satisfaction.