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
Summary Audit and authorize reimbursement of specific medical stop loss claims. Effectively mitigate client medical stop loss claims and provide excellent customer service. Description Position Purpose Audit and authorize reimbursement of specific medical stop loss claims.
Essential Duties and Responsibilities: - Generate and implement efficient sourcing and category management strategies through the RFx process. - Develop and negotiate contracts with new suppliers and/or renegotiate existing contracts to accomplish the lowest total system
Essential Duties and Responsibilities: - Responsible for directing all quality operations including planning, implementation monitoring and reporting functions. - Develop and oversee an effective management system to continuously identify opportunities for improvement while maintaining adherence to
Essential Duties and Responsibilities: - Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments. - Provide written clinical rationales for CA Workers Compensation