Operations Analyst – ECR Inquiry & Dispute Intake

About this role

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 Position Overview The Operations Analyst – ECR Inquiry & Dispute Intake is responsible for managing the daily intake, screening, classification, and routing of incoming Expert Claims Review (ECR) inquiries and disputes. This role serves as the primary operational owner of the inquiry and dispute intake process, ensuring work is accurately categorized, prioritized, and routed to the appropriate teams while supporting client service level agreements (SLAs) and operational excellence. The Operations Analyst leverages AI-enabled workflow automation and analytics to optimize intake processes, monitor automation performance, identify process improvement opportunities, and provide operational reporting and insights. This position plays a critical role in supporting timely dispute resolution, enhancing client satisfaction, reducing provider abrasion, and creating a scalable operating model for future growth.

Key Responsibilities • Manage the daily intake, screening, classification, and distribution of incoming ECR inquiries and disputes across ECR solutions. • Review incoming work to accurately distinguish standard inquiries from disputes requiring formal review and ensure timely routing to the appropriate operational teams. • Monitor intake workflow performance to ensure adherence to client SLAs and operational performance standards. • Serve as the operational owner of the inquiry and dispute intake process, ensuring consistent application of business rules and routing criteria. • Monitor AI-assisted triage and automation performance, identifying exceptions, validating routing accuracy, and escalating issues as appropriate. • Partner with business and technology teams to identify opportunities for workflow automation, process optimization, and continuous operational improvement. • Analyze inquiry and dispute trends, workload distribution, and operational metrics to provide actionable reporting and recommendations. • Support workload balancing across onshore and offshore resources where applicable while maintaining ownership of the overall intake process. • Collaborate with Operations leadership, dispute reviewers, implementation teams, and cross-functional partners to resolve workflow issues and improve operational efficiency. • Assist with developing and maintaining standard operating procedures, job aids, and process documentation. • Support training and onboarding of new team members related to inquiry and dispute intake processes. • Maintain a thorough understanding of ECR clients, business processes, client-specific contractual requirements, workflow management, and operational priorities. • Ensure compliance with Zelis policies, privacy standards, and regulatory requirements while handling confidential client and provider information. • Participate in special projects, operational initiatives, and other duties as assigned.

  Professional Experience • High School Diploma required; Associate or Bachelor's degree preferred. • 2+ years of experience within the healthcare industry preferred. • Experience in healthcare claims processing, medical billing, provider operations, dispute management, or revenue cycle operations preferred. • Experience managing operational workflows, intake processes, or claim routing functions preferred. • Experience working with AI-enabled workflow tools, automation platforms, or operational technology solutions is a plus. • Strong analytical and problem-solving skills with the ability to identify trends and recommend process improvements. • Excellent written and verbal communication skills. • Strong organizational, prioritization, and time management skills with the ability to manage multiple competing priorities. • Proficiency with Microsoft Office Suite, including Excel, Word, and Outlook. • Experience using claims management systems and workflow management platforms preferred.

  Knowledge, Skills & Abilities • Strong understanding of healthcare claims operations and revenue cycle processes. • Ability to interpret operational procedures, client requirements, and business rules to make accurate intake and routing decisions. • Strong analytical mindset with experience utilizing operational data to drive decision-making. • Ability to monitor operational performance and identify opportunities for continuous improvement. • High attention to detail and commitment to quality and accuracy. • Ability to work independently while collaborating effectively across multiple teams. • Strong customer service orientation with a focus on deliverin

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