Jobs at Zelis

Provide first-line client support via phone, email, and meetings; manage client accounts, resolve and escalate issues, coordinate with internal teams, maintain records and reports, identify issue trends, promote products, and contribute to client service strategies to ensure satisfaction and retention.

Support implementation team to configure Zelis systems for payer clients, manage project plans, gather requirements, redesign communications, troubleshoot data integrations, and drive customers to production while ensuring HIPAA compliance and client satisfaction.

Serve as primary Zelis contact for an assigned book of payer/TPA clients to drive retention, renewals, and revenue growth. Build executive relationships, conduct business reviews, identify risks and upsell opportunities, collaborate cross-functionally, and leverage data to demonstrate client value while meeting revenue targets.

Lead process improvement initiatives: design and implement process enhancements, troubleshoot complex operational issues, run small projects, produce data-driven analysis, maintain SOPs and documentation, build dashboards/reports, train junior staff, and act as SME for operational tools and workflows.

Lead the Software Composition Analysis (SCA) program: manage artifact repositories, identify and remediate open-source vulnerabilities and license risk, maintain SBOMs, integrate SCA/SAST/DAST into CI/CD, triage findings, conduct code reviews, train engineering teams, and track application security metrics.

Develop, build, test, and maintain claims edit logic and edit suites using industry sources (AMA, CPT, CMS). Provide medical coding expertise, client support, documentation, QA, HIPAA compliance, trend monitoring, and cross-functional collaboration for claims edit platform improvements.

Develop and maintain claims editing content using medical coding sources (ICD-10, CPT, CMS, AAPC/AHIMA). Perform regulatory research, analyze data impact, support client inquiries, partner with Product and Ops, ensure QA and privacy adherence, and recommend content enhancements and automation opportunities.

Develop, maintain, and test clinical edits and associated content for the Claims Editing library. Perform regulatory and coding research, ensure HIPAA compliance, validate and QA edit content, monitor coding trends, and support client and provider inquiries with documented rationale. Serve as a subject matter expert and partner across teams on content impact and updates.

The Client Business Analyst will analyze and present data for clients, monitor performance metrics, and support product implementation and revenue optimization activities.

Lead a global QA team to drive test automation, shift-left practices, and release readiness for .NET-based products. Own automation frameworks, integration/E2E and performance testing, ETL and AWS migration quality, PHI test data strategies, KPIs and executive reporting, hiring and coaching, and modernizing legacy QA into AI-enabled, high-performing teams.

Serve as primary client contact for an assigned book, driving retention, renewals, revenue growth, and cross-sell. Manage risk, escalations, reporting, SLA compliance, business reviews, and implementation support while coordinating internal teams and ensuring client satisfaction and timely financial performance.

Serve as a post-implementation, client-facing advisor for a portfolio of small-to-medium accounts. Drive product adoption, demonstrate value using data insights, manage escalations and SLAs, perform account planning, identify upsell/cross-sell opportunities, coordinate with Sales/Product/Implementation, and maintain CRM/JIRA records and client reporting to optimize performance and client satisfaction.

Lead U.S. healthcare product vision and roadmap, translate stakeholder requirements into prioritized backlog items, drive feature definition and releases, ensure HIPAA and regulatory compliance, apply provider network and member engagement expertise, and lead agile ceremonies to deliver value with development and QA teams.

The IBR Reviewer at Zelis analyzes medical insurance claims, ensuring compliance with coding and billing guidelines, while optimizing the financial experience for healthcare providers.

Design, implement, and tune WAF policies for web apps and APIs; mitigate OWASP Top 10 risks, bot abuse, and L7 DDoS; integrate WAF logs with SIEM; automate deployments with IaC and CI/CD; support incident response, perform rule tuning to reduce false positives, and collaborate with DevOps/SRE and app teams to maintain security and performance.

Lead and coach a remote team of up to 20 Payee Services Representatives to meet KPIs. Oversee daily call center operations, scheduling, quality monitoring, escalations, reporting, hiring, and timecard approvals. Drive process improvements, conduct 1:1s and team meetings, and ensure compliance with company standards.

Designs, standardizes, migrates, transforms, validates and optimizes data across multi-database platforms. Builds and maintains ETL pipelines, supports client data lifecycles, troubleshoots production defects, contributes across SDLC, and maintains code in GitHub. Supports off-hours processing and ensures data quality and policy adherence.

The UAT Analyst will conduct UAT testing for healthcare claim editing projects, ensuring system functionality, accuracy, and quality through detailed test planning, execution, and analysis.

Design, build, and operate core backend systems and end-to-end solutions. Own production services, drive architecture, improve CI/CD and infrastructure automation, mentor engineers, and ensure scalability, reliability, security, and observability.

Lead revenue forecasting, capacity planning, and financial modeling for Price Optimization. Drive data-informed decision-making while managing budgets and operational efficiency.