Position Overview
The Carrier Relations Manager position is responsible for successfully managing the Carrier Relations team. The Carrier Relations team is a critical role within Zelis Network Analytics (ZNA) ProviderNexus API business, responsible for implementation of requests for customized data sets from our clients, which includes gathering, clarifying, and transferring custom business rules from our carrier partners to our Data Operations team and our proprietary data mapping application.
This role will be responsible for managing the team’s personnel, assigning work, training and mentoring team members and assisting with questions and escalations as they arise.
The Carrier Relations Manager will also be responsible for establishing and monitoring performance metrics for the team, working equally well in both technical and non-technical environments and effectively communicating technical information in a common, non-technical manner.
The individual must work well in a fast paced, demanding environment. The ability to efficiently organize and prioritize work to meet deadlines is essential to success.
Key Responsibilities
Escalation resource for all team members, as well as internal and external clients
Ensure Root Cause Analysis documents for client issues are clear and accurate
Establish and manage to team goals with performance metrics
Perform team reviews and performance management
Work with team to document processes, and update existing processes
Work with carriers to negotiate carrier data use agreements, ensuring terms are acceptable; work with Zelis & Carrier legal teams to execute agreements
Coach and mentor team members to :
Facilitate meetings, internal & external
Manage all communications, internal & external
Track progress of tasks
Manage agreements and document updates
Collaborate with other ZNA teams to document identified gaps or missing process needs and implement process improvements as needed
Summary of Qualifications
Associate degree minimum / Bachelor’s preferred
6+ years of management experience preferred
4+ years of experience in the healthcare industry preferred industry (particularly in the realm of provider networks and directories)
Thorough understanding of data structure basics, with knowledge of how to apply business rules to retrieve data from those formats is required
Innovative problem-solver who constructively overcomes obstacles utilizing resourceful solutions
Demonstrates ability to lead in a collaborative, team setting
Tools used :
SQL or other data management tools
Trello.com
Confluence
Internal data management system
Office products Word, Excel, Outlook, PowerPoint
LI-RZ1
As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members.
We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all.
We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care.
Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.
Zelis provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type 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.
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