Ops Analyst, DRG

Responsibilities

• Managing the screening and distribution processes of Expert Claim Review Claims supporting the end-to-end workflow audit for Zelis Prepay and Post-pay Programs.
• Assist with training and onboarding of new team members.
• Monitor new client claims post-implementation to ensure high performance per client requirements.
• Thoroughly understand all ECR clients, business processes, inventory management, file processes, and financial recovery tracking.
• Accountable for the deployment of resources for the management of daily claims screening, distribution, and referral processes, including ECR and ECR-EDI, DRG Validation and DRG Outlier pricing.
• Accountable for ensuring all ECR claims are managed per client requirements.
• Maintain awareness of and ensure adherence to Zelis standards regarding privacy.

Requirements

• High School Diploma required. Associate degree preferred.
• 2+ years of experience within the healthcare industry preferred.
• Solid written & verbal communication skills.
• Strong prioritizing & organizational skills.
• Excellent typing/data entry skills.
• Experience in claim processing, medical billing, or related a plus.
• Strong working knowledge of Microsoft Office suite as well as Adobe Acrobat.
• Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.
• Location and Workplace Flexibility
• While location expectations vary by role, candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in-office presence is guided by team and business needs rather than a fixed weekly schedule.
• Base Salary Range
• $54,000.00 - $68,400.00
• 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, disa

Benefits

Additional Information

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 top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients. At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture. A Little About You 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 Operations Analyst, DRG will provide daily operational support to the Expert Claims Review team, including the itemized bill review and DRG validation teams. Responsibilities include reporting, claims management, analysis, client savings identification, digitized records QA, and in-depth knowledge of client contractual parameters.

Your Match

How well this role fits your profile.

Company Intel

What employees say

Worked at zelis? Share your experience