Sr. Director, Claims Pricing
Zelis · Morristown, NJ · 1 mo ago
$169k–$214k/yrFull-time
We need to output HTML fragment with sections: About the role? Actually we have sections: About the role (maybe "Position Overview"?), Responsibilities (What You'll Do), Requirements (Required (What You'll Bring to Zelis), Benefits (benefits description), Pay (Base Salary Range), maybe Schedule (travel requirement). Also maybe "Location and Workplace Flexibility" could be part of Schedule? But schedule is about travel 25%-50% and location preferences. We can include a Schedule section with travel requirement and location flexibility. Also Benefits: mention 401k, PTO, holidays, parental leaves, life/disability insurance, health benefits.
We must not repeat job title. No headings for Job ID etc. Remove boilerplate: EEO, equal opportunity, etc. Also remove navigation, cookie, legal, scam warning, application instructions. Also remove "At Zelis we Get Stuff Done..." introductory fluff? That's part of About Us; we need to preserve substantive information but can we drop fluff? The instruction: "Preserve ALL substantive information; do NOT invent or summarize away detail." So we need to keep substantive info but can we remove marketing fluff? The "At Zelis, we Get Stuff Done..." is maybe not substantive? It's a tagline. Might be considered boilerplate? Not sure. Safer to keep it? But it's not a section heading; it's just prose. We could keep as a paragraph under maybe an "About the company" but we don't have a heading for that. The instruction says use for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It doesn't require an About the company section. So we could omit that introductory fluff as not required. However we must preserve ALL substantive information; is that fluff substantive? Probably not essential to the job. Might be considered boilerplate. I'd drop it.
We need sections only when posting has real specific content. We have:
- Position Overview (could be "About the role") includes description of role.
- What You'll Do (Responsibilities) includes bullet points.
- Required What You'll Bring to Zelis (Requirements) includes bullet points.
- Benefits: description of benefits.
- Pay: Base Salary Range.
- Schedule: travel 25%-50% and location flexibility.
We also have "Location and Workplace Flexibility" which could be part of Schedule.
We need to use
for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It doesn't require an About the company section. So we could omit that introductory fluff as not required. However we must preserve ALL substantive information; is that fluff substantive? Probably not essential to the job. Might be considered boilerplate. I'd drop it.
We need sections only when posting has real specific content. We have:
- Position Overview (could be "About the role") includes description of role.
- What You'll Do (Responsibilities) includes bullet points.
- Required What You'll Bring to Zelis (Requirements) includes bullet points.
- Benefits: description of benefits.
- Pay: Base Salary Range.
- Schedule: travel 25%-50% and location flexibility.
We also have "Location and Workplace Flexibility" which could be part of Schedule.
We need to use - for any list of duties/requirements/benefits. So for responsibilities list, we need to convert each bullet into
- . For requirements list similarly. For benefits list also.
We must not create sections with filler like "commensurate with experience". In Requirements we have "Bachelor’s degree in a related field or commensurate experience." That's a phrase; we should keep it as is; it's not a placeholder like "N/A". It's okay.
We must not include Pay/Schedule/Benefits sections unless posting actually states them. They do.
Now produce HTML fragment.
Structure:
About the role
... position overview paragraph(s) ...
Responsibilities
- ...
...
Requirements
- ...
...
Benefits
- ...
...
Pay
Base Salary Range $169,000.00 - $213,750.00
Schedule
Must be available to travel 25% - 50% as required to meet business needs. 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.
We need to ensure we preserve all substantive information from the posting. Let's extract details.
About the role (Position Overview) text:
"As part of the Pricing Solutions division, this role leads strategic initiatives that improve the performance, efficiency, scalability, and future readiness of the Claims Pricing & Revenue organization. This role works closely with Claims Pricing & Revenue leadership to translate business priorities into actionable plans, strengthen operating performance, and identify opportunities to modernize claims pricing, repricing, negotiation, and related revenue operations. Initially serving as a senior individual contributor, the Senior Director leads complex, cross-functional work through influence, subject-matter expertise, and strong execution. The role may lead a team in the future as the organization’s transformation agenda and capabilities expand. The Senior Director partners across Operations, Product, Technology, Analytics & Insights, Finance, Networks, Client Services and other key stakeholders to improve how work is performed and measured. The role will be particularly focused on identifying and implementing AI, automation, globalization, and workflow opportunities that improve productivity, quality, turnaround time, cost-to-serve, and margin performance."
We'll put that in .
Responsibilities: The "What You'll Do" section includes several sub-sections: Strategic Initiatives and Functional Transformation, AI, Automation and Operational Innovation, Claims Pricing and Revenue Operations Optimization, Operational Performance, KPIs and Feedback Loops, Cross-Functional Leadership and Partnership, Client Escalations, Organizational Capability and Workforce Readiness. Each has bullet-like paragraphs. We need to convert each bullet into
- . However the text is paragraph style, not bullet list. But we can treat each paragraph as a list item. The instruction: Use
- for any list of duties/requirements/benefits. The posting uses headings and paragraphs; we can still create
- for each distinct duty. We'll break them out.
Let's extract each duty:
Under Strategic Initiatives and Functional Transformation:
- Lead high-priority initiatives that advance the Claims Pricing & Revenue strategy and improve the organization’s long-term performance.
- Translate strategic priorities into practical roadmaps, work plans, milestones, ownership, and measurable outcomes.
- Identify opportunities to simplify work, reduce fragmentation, eliminate unnecessary handoffs, and improve coordination across claims pricing, repricing, and negotiation functions.
- Evaluate current operating practices and recommend changes that improve scalability, consistency, quality, and margin performance.
- Lead initiatives that span multiple products, operational teams, systems, or stakeholder groups.
- Surface risks, dependencies, resource requirements, and tradeoffs to support leadership decisions and prioritization.
AI, Automation and Operational Innovation:
- Partner key stakeholders and operational leaders to identify high-value AI, automation, and workflow opportunities.
- Assess opportunities based on operational impact, feasibility, capacity released, quality improvement, cost, risk, and expected return.
- Develop implementation plans that clearly define the business need, expected outcome, workflow change, resource requirements, adoption approach, and performance measures.
- Help move initiatives from concept through implementation by coordinating the appropriate operational, product, technology, and business stakeholders.
- Identify repeatable capabilities that can be standardized or scaled across claims pricing and revenue teams.
- Support globalization strategies responsibly while maintaining quality, regulatory compliance, and client performance.
- Monitor adoption and business results to ensure implemented solutions deliver the intended value.
Claims Pricing and Revenue Operations Optimization:
- Develop an end-to-end understanding of claims pricing, repricing, prepay and post-pay negotiations, revenue realization, and associated operational workflows.
- Identify opportunities to improve throughput, accuracy, cycle time, quality, workforce utilization, and cost-to-serve.
- Partner with operational leaders to address performance gaps, bottlenecks, duplicative work, and inconsistent processes across teams.
- Recommend operating-model, workflow, resource, or capability changes that enable the function to scale efficiently.
- Ensure operational improvements support the commercial, financial, regulatory, and client commitments of the business.
- Support evaluation of which activities should be automated, standardized, centralized, globalized, redesigned, or discontinued.
Operational Performance, KPIs and Feedback Loops:
- Partner with Analytics & Insights and Process Excellence to define the KPIs required to manage Claims Pricing & Revenue performance.
- Establish measures for productivity, throughput, quality, cycle time, automation adoption, negotiation outcomes, resource utilization, cost-to-serve, and other relevant business results.
- Help to ensure capacity models are developed to support the operations of the business.
- Ensure leaders have clear, reliable dashboards and performance insights that support timely decisions.
- Analyze performance trends and identify emerging risks, recurring issues, and opportunities for improvement.
- Establish feedback loops among Business Operations, Product Strategy, Product Delivery, Technology, Finance, and Process Excellence.
- Use operational findings to inform product enhancements, technology priorities, process changes, workforce plans, and future strategic initiatives.
- Measure the impact and return of operational changes and recommend adjustments where expected benefits are not being achieved.
Cross-Functional Leadership and Partnership:
- Serve as a strategic advisor to Claims Pricing & Revenue leadership on operating performance, transformation priorities, and organizational opportunities.
- Lead cross-functional initiatives without relying on direct reporting authority.
- Build alignment across teams with different priorities, operating models, and areas of expertise.
- Partner with Finance on profitability analysis, financial implications, capacity investments, cost-to-serve, and business cases while preserving Finance’s ownership of product pricing and financial validation.
- Partner with Product Strategy to communicate operational needs, recurring client themes, and capability opportunities that may affect product direction.
- Partner with Product Delivery and Technology to translate approved priorities into implementable solutions.
- Partner with Process Excellence on work intake, prioritization, process redesign, adoption, and measurement.
- Communicate progress, risks, decisions, and results clearly to senior leaders and other stakeholders.
Client Escalations:
- Lead or coordinate resolution of select complex and high-impact client escalations.
- Bring together the appropriate operational, client, product, technical, compliance, network, and financial stakeholders.
- Clarify accountability, action plans, timelines, communications, and decision points.
- Distinguish immediate client resolution from longer-term systemic improvement.
- Identify recurring escalation themes and use them to inform process, product, training, or operating-model changes.
- Ensure resolutions are sustainable and do not create unnecessary manual work or operational risk.
Organizational Capability and Workforce Readiness:
- Identify the skills, roles, capacity, and operating capabilities required to execute the future Claims Pricing & Revenue strategy.
- Support workforce planning and recommendations related to upskilling, reskilling, globalization, role redesign, and future hiring.
- Develop repeatable approaches, tools, and frameworks that improve how strategic initiatives are managed across the function.
- Support change adoption by helping leaders and teams understand new workflows, responsibilities, performance expectations, and measures.
- If the role develops into a people-leadership position, build and lead a high-performing team focused on strategic initiatives and functional transformation.
That's a lot of items. We'll put them all in one
under Responsibilities.
Requirements: "What You'll Bring to Zelis:" includes bullet points:
- Bachelor’s degree in a related field or commensurate experience.
- 12+ years of progressive experience in healthcare operations, claims pricing, reimbursement, payment integrity, revenue operations, consulting, transformation, or a related field.
- Significant experience leading complex, cross-functional initiatives with measurable operational or financial outcomes.
- Demonstrated knowledge of healthcare claims pricing, repricing, reimbursement, negotiations, payer operations, or related revenue workflows.
- Experience identifying and implementing automation, AI, workflow, or technology-enabled operational improvements.
- Experience developing performance measures, operational dashboards, business cases, or benefit-realization plans.
- Experience influencing senior leaders and driving decisions in a highly matrixed environment.
- Experience managing complex client or business escalations preferred.
- People-leadership experience is beneficial but not required at appointment; the ability to build and lead a future team is important.
- Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.
We need to keep the visa sponsorship note as a requirement? It's a restriction; we can include as a list item.
Benefits: The posting says: "Zelis’ full-time associates
About the role
... position overview paragraph(s) ...
Responsibilities
- ... ...
Requirements
- ... ...
Benefits
- ... ...
Pay
Base Salary Range $169,000.00 - $213,750.00
Schedule
Must be available to travel 25% - 50% as required to meet business needs. 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.
We need to ensure we preserve all substantive information from the posting. Let's extract details. About the role (Position Overview) text: "As part of the Pricing Solutions division, this role leads strategic initiatives that improve the performance, efficiency, scalability, and future readiness of the Claims Pricing & Revenue organization. This role works closely with Claims Pricing & Revenue leadership to translate business priorities into actionable plans, strengthen operating performance, and identify opportunities to modernize claims pricing, repricing, negotiation, and related revenue operations. Initially serving as a senior individual contributor, the Senior Director leads complex, cross-functional work through influence, subject-matter expertise, and strong execution. The role may lead a team in the future as the organization’s transformation agenda and capabilities expand. The Senior Director partners across Operations, Product, Technology, Analytics & Insights, Finance, Networks, Client Services and other key stakeholders to improve how work is performed and measured. The role will be particularly focused on identifying and implementing AI, automation, globalization, and workflow opportunities that improve productivity, quality, turnaround time, cost-to-serve, and margin performance." We'll put that in. Responsibilities: The "What You'll Do" section includes several sub-sections: Strategic Initiatives and Functional Transformation, AI, Automation and Operational Innovation, Claims Pricing and Revenue Operations Optimization, Operational Performance, KPIs and Feedback Loops, Cross-Functional Leadership and Partnership, Client Escalations, Organizational Capability and Workforce Readiness. Each has bullet-like paragraphs. We need to convert each bullet into
- for any list of duties/requirements/benefits. The posting uses headings and paragraphs; we can still create
- for each distinct duty. We'll break them out.
Let's extract each duty:
Under Strategic Initiatives and Functional Transformation:
- Lead high-priority initiatives that advance the Claims Pricing & Revenue strategy and improve the organization’s long-term performance.
- Translate strategic priorities into practical roadmaps, work plans, milestones, ownership, and measurable outcomes.
- Identify opportunities to simplify work, reduce fragmentation, eliminate unnecessary handoffs, and improve coordination across claims pricing, repricing, and negotiation functions.
- Evaluate current operating practices and recommend changes that improve scalability, consistency, quality, and margin performance.
- Lead initiatives that span multiple products, operational teams, systems, or stakeholder groups.
- Surface risks, dependencies, resource requirements, and tradeoffs to support leadership decisions and prioritization.
AI, Automation and Operational Innovation:
- Partner key stakeholders and operational leaders to identify high-value AI, automation, and workflow opportunities.
- Assess opportunities based on operational impact, feasibility, capacity released, quality improvement, cost, risk, and expected return.
- Develop implementation plans that clearly define the business need, expected outcome, workflow change, resource requirements, adoption approach, and performance measures.
- Help move initiatives from concept through implementation by coordinating the appropriate operational, product, technology, and business stakeholders.
- Identify repeatable capabilities that can be standardized or scaled across claims pricing and revenue teams.
- Support globalization strategies responsibly while maintaining quality, regulatory compliance, and client performance.
- Monitor adoption and business results to ensure implemented solutions deliver the intended value.
Claims Pricing and Revenue Operations Optimization:
- Develop an end-to-end understanding of claims pricing, repricing, prepay and post-pay negotiations, revenue realization, and associated operational workflows.
- Identify opportunities to improve throughput, accuracy, cycle time, quality, workforce utilization, and cost-to-serve.
- Partner with operational leaders to address performance gaps, bottlenecks, duplicative work, and inconsistent processes across teams.
- Recommend operating-model, workflow, resource, or capability changes that enable the function to scale efficiently.
- Ensure operational improvements support the commercial, financial, regulatory, and client commitments of the business.
- Support evaluation of which activities should be automated, standardized, centralized, globalized, redesigned, or discontinued.
Operational Performance, KPIs and Feedback Loops:
- Partner with Analytics & Insights and Process Excellence to define the KPIs required to manage Claims Pricing & Revenue performance.
- Establish measures for productivity, throughput, quality, cycle time, automation adoption, negotiation outcomes, resource utilization, cost-to-serve, and other relevant business results.
- Help to ensure capacity models are developed to support the operations of the business.
- Ensure leaders have clear, reliable dashboards and performance insights that support timely decisions.
- Analyze performance trends and identify emerging risks, recurring issues, and opportunities for improvement.
- Establish feedback loops among Business Operations, Product Strategy, Product Delivery, Technology, Finance, and Process Excellence.
- Use operational findings to inform product enhancements, technology priorities, process changes, workforce plans, and future strategic initiatives.
- Measure the impact and return of operational changes and recommend adjustments where expected benefits are not being achieved.
Cross-Functional Leadership and Partnership:
- Serve as a strategic advisor to Claims Pricing & Revenue leadership on operating performance, transformation priorities, and organizational opportunities.
- Lead cross-functional initiatives without relying on direct reporting authority.
- Build alignment across teams with different priorities, operating models, and areas of expertise.
- Partner with Finance on profitability analysis, financial implications, capacity investments, cost-to-serve, and business cases while preserving Finance’s ownership of product pricing and financial validation.
- Partner with Product Strategy to communicate operational needs, recurring client themes, and capability opportunities that may affect product direction.
- Partner with Product Delivery and Technology to translate approved priorities into implementable solutions.
- Partner with Process Excellence on work intake, prioritization, process redesign, adoption, and measurement.
- Communicate progress, risks, decisions, and results clearly to senior leaders and other stakeholders.
Client Escalations:
- Lead or coordinate resolution of select complex and high-impact client escalations.
- Bring together the appropriate operational, client, product, technical, compliance, network, and financial stakeholders.
- Clarify accountability, action plans, timelines, communications, and decision points.
- Distinguish immediate client resolution from longer-term systemic improvement.
- Identify recurring escalation themes and use them to inform process, product, training, or operating-model changes.
- Ensure resolutions are sustainable and do not create unnecessary manual work or operational risk.
Organizational Capability and Workforce Readiness:
- Identify the skills, roles, capacity, and operating capabilities required to execute the future Claims Pricing & Revenue strategy.
- Support workforce planning and recommendations related to upskilling, reskilling, globalization, role redesign, and future hiring.
- Develop repeatable approaches, tools, and frameworks that improve how strategic initiatives are managed across the function.
- Support change adoption by helping leaders and teams understand new workflows, responsibilities, performance expectations, and measures.
- If the role develops into a people-leadership position, build and lead a high-performing team focused on strategic initiatives and functional transformation.
That's a lot of items. We'll put them all in one
- under Responsibilities.
Requirements: "What You'll Bring to Zelis:" includes bullet points:
- Bachelor’s degree in a related field or commensurate experience.
- 12+ years of progressive experience in healthcare operations, claims pricing, reimbursement, payment integrity, revenue operations, consulting, transformation, or a related field.
- Significant experience leading complex, cross-functional initiatives with measurable operational or financial outcomes.
- Demonstrated knowledge of healthcare claims pricing, repricing, reimbursement, negotiations, payer operations, or related revenue workflows.
- Experience identifying and implementing automation, AI, workflow, or technology-enabled operational improvements.
- Experience developing performance measures, operational dashboards, business cases, or benefit-realization plans.
- Experience influencing senior leaders and driving decisions in a highly matrixed environment.
- Experience managing complex client or business escalations preferred.
- People-leadership experience is beneficial but not required at appointment; the ability to build and lead a future team is important.
- Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.
We need to keep the visa sponsorship note as a requirement? It's a restriction; we can include as a list item.
Benefits: The posting says: "Zelis’ full-time associates