Client Business Analyst

About Us

Zelis is modernizing the healthcare financial experience in the United States (U.S.) 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.

Why We Do What We Do

In the U.S., consumers, payers, and providers face significant challenges throughout the healthcare financial journey. Zelis helps streamline the process by offering solutions that improve transparency, efficiency, and communication among all parties involved. By addressing the obstacles that patients face in accessing care, navigating the intricacies of insurance claims, and the logistical challenges healthcare providers encounter with processing payments, Zelis aims to create a more seamless and effective healthcare financial system.

Zelis India plays a crucial role in this mission by supporting various initiatives that enhance the healthcare financial experience. The local team contributes to the development and implementation of innovative solutions, ensuring that technology and processes are optimized for efficiency and effectiveness. Beyond operational expertise, Zelis India cultivates a collaborative work culture, leadership development, and global exposure, creating a dynamic environment for professional growth. With hybrid work flexibility, comprehensive healthcare benefits, financial wellness programs, and cultural celebrations, we foster a holistic workplace experience. Additionally, the team plays a vital role in maintaining high standards of service delivery and contributes to Zelis’ award-winning culture.

Position Overview

The Client Business Analyst (CBA) will be responsible for monitoring, analyzing, summarizing and presenting data for all assigned editing clients. The Client Business Analyst will work as part of the Client Policy Integration team to provide monthly performance summaries which includes but is not limited to trends, edit utilization, outliers and impact of requested edit customizations. This role will provide a major contribution enhancing the overall capacity of the Client Policy Integration team to meet the key performance goals for client edit adoption and revenue optimization. The Client Business Analyst will ensure day-to-day activities align with the overall mission and adherence to best practice policies.

ESSENTIAL FUNCTIONS:

• 5–10 years of relevant experience, or an equivalent combination of education and work experience, with healthcare payers.

• Current certified coder (AAPC or AHIMA), RHIA/RHIT certification, or RN/LPN with coding knowledge preferred, but not required

• Demonstrate an expert level understanding of all Zelis editing products with an ability to clearly articulate correct coding/claim adjudication guidelines, and interpretation of client policies.

• Perform revenue optimization analysis for Zelis editing products and assigned accounts as defined by the business unit (external and internal customers).

• Demonstrate expertise in auditing claims processes and edit performance validation with ability to document root-cause analysis for escalation and resolution.

• Partner with Client Integration Specialist team to support the implementation of the Zelis editing product which includes but is not limited to data review, interpreting client policies, guidance for requested client customizations and support testing and client “go-live”.

• Support the research/validation of new edit concepts, pre-production data analysis, determine client selection based on edit volume/potential savings opportunity and support new edit communication/rollout strategies.

• Critically evaluate information gathered from multiple sources, reconcile conflicts and provide a synopsis of findings

• Weekly, monthly and quarterly client financial KPI analysis; monitor client trends, work with assigned teams to report/escalate issues that would affect daily business operations.

• Proactively escalate identified claim adjudication issues utilizing all tools and resources to document and resolve

• Perform monthly performance analysis with detailed summary for edit trends, utilization, adoption, opportunity pipeline, revenue variances and forecasting.

• Conduct ad hoc analysis as requested per assigned clients.

• Assist in project management of financial forecasting, budgeting and trend analysis details.

• Work with assigned aforementioned teams to design and build reports/templates to present monthly performance trends to assigned clients/internal teams.

• Completes all responsibilities as outlined on annual Performance Plan

• Completed all special projects and other duties as assigned

• Ensure compliance with HIPAA regulations and requirements.

• undefined

Education Qualification

Graduate

Commitment to Diversity, Equity, Inclusion, and Belonging

At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

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.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability and require reasonable accommodation with any part of the application and/or interview process, please email talentacquisition@zelis.com.