Claims Settlement Specialist

US FL St. Petersburg

Full time

JR111865

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

This is an entry-level position responsible for handling and negotiating claims settlements with policyholders, claimants, and third parties. This role involves evaluating claims, determining liability, and negotiating fair settlements in accordance with company policies and procedures. The ideal candidate will have strong communication skills, attention to detail, and a basic understanding of claims processes.

What You’ll Do:

• Review and analyze simple claims to determine coverage, liability, and damages.

• Gather and assess relevant documentation, including medical records, police reports, and witness statements.

• Conduct initial investigations to verify the validity of claims.

• Communicate with policyholders, claimants, and third parties to negotiate fair and timely settlements.

• Present simple settlement offers and explain the basis for the offer to all parties involved.

• Document all negotiations and settlement agreements accurately in the claims management system.

• Provide excellent customer service by addressing inquiries and concerns promptly and professionally.

• Educate policyholders and claimants on the claims process and their rights and responsibilities.

• Maintain a positive and empathetic attitude when dealing with claimants.

• Ensure all claims are handled in compliance with company policies, procedures, and regulatory requirements.

• Maintain accurate and detailed records of all claims' activities and communications.

• Assist in preparing reports and summaries of claims activities for management review.

What You’ll Bring to Zelis:

• Typically has a BA or 3-5 years of experience; Attends company training and local meetings in field

• Requires proficiency using AI tools skillfully with an understanding of how to develop/create intelligent prompts and/or agents.

• Strong communication and negotiation skills.

• Basic understanding of claims processes and insurance principles.

• Proficiency in Microsoft Office Suite and claims management software.

• Ability to work independently and manage time effectively.

• Experience in the insurance industry.

• Knowledge of state and federal regulations related to claims handling.

• Strong analytical and problem-solving skills.

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

Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations (https://careers.zelis.com/us/en/locations) to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-office work and activities vary based on work and team objectives in accordance with Company policies.

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.

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 [email protected].

Disclaimer

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.

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.

Zelis maintains a transparent, fee-free recruitment process. All genuine offers originate from our Talent Acquisition team using the “@zelis.com” domain. We do not use WhatsApp or personal emails for recruitment. Forward any suspected fraud to [email protected] for prompt investigation. Thank you for staying vigilant.