At Zelis, we Get Stuff Done. So, let's get to it! Zelis is modernizing the healthcare financial experience for all by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts-driving real, measurable results for clients. You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are. Position Overview The Senior Director of the Claims Edit Product is a management role responsible for working closely across product management, operations, and technology teams to ensure execution and delivery of new edits. Specifically, this role will be responsible for leading the Data-Driven Edits team and driving forward the edits roadmap, including special initiatives such as artificial intelligence, content expansion and growth. The Data-Driven Edits team manages new edit content, the edit backlog, and sourcing of edits (e.g. AMA, CPT, CMS, etc.).
What you'll do:
Drive strategy and development for Claims Editing content expansion and growth. Prepare and communicate program level status reporting (e.g. roadmaps) to key constituents, stakeholders, and executive team. Provide guidance to the Product Owners on the refinement features and roadmap items in the backlog; collaborate with teams to define the acceptance criteria and definition of done for a feature/item. Support launch of new products and content expansion. Serve as a subject matter expert for content and edits and provide support where needed including sales, client facing teams and clients. Monitor, research, and summarize trends, coding practices, and regulatory changes; keep abreast of compliance and regulation changes to identify enhancements and additional editing opportunities. Work closely with Sales, Marketing and Operations to provide coding and product expertise (e.g. Present at Client Forums and webinars). Actively contribute new ideas and support ad hoc projects, including time-sensitive requests. Lead assessment of new opportunities for Claims Edits with artificial intelligence. Accurately scopes out projects, sets objectives, and goals, develops schedules, measures performance against goals, and evaluates results. Use of strong coding and industry knowledge to create and maintain editing content. Ensure adherence to quality assurance guidelines. Support for client facing teams as needed relating to client inquiries. Partner with other areas to assess and communicate impact to the business for additions, changes, or updates as it relates to content and edit updates. Utilize the most up-to-date approved Zelis medical coding sources for edit maintenance and development while also advising appropriate personnel of important changes, issues, and trends. Maintains awareness of and ensure adherence to ZELIS standards regarding privacy.
What you'll bring to Zelis:
10-12+ years of product management or product delivery experience. Certified coder experience (CCS, CCS-P or CPC), or registered health information technician (RHIA/RHIT), or RN, LPN with coding knowledge. A hands-on leader who thrives in an entrepreneurial, collaborative, and growth-oriented environment. Familiarity with Agile software development processes. Background and / or understanding of the healthcare industry. Creative problem-solving skills, leveraging insights and input from other parts of an organization. Demonstrated leadership ability with cross-functional teams, knows how to get things done both through formal channels and the informal network. Ability to think and act strategically, and as well as execute tactically with bias toward action. Consistently demonstrate ability to act and react swiftly to continuous challenges and changes. Excellent analytical skills with data and analytics related solutions. Excellent communication skills. Strong organization and project / process management skills. Strong initiative, self-directed and self-motivation. Good negotiation, problem solving, planning and decision-making skills. Travel requirements to (primarily) domestic destinations should not exceed 10%
Location and Workplace Flexibility We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.
Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment 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.
We welcome applicants from all backgrounds and encourage you to apply even if you don't meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all. Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.
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Zelis Healthcare, LLC
Apr 23, 2025