Operations Analyst – ECR Inquiry & Dispute Intake

Zelis • Boston, MA

21h • Hybrid

About The Position

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.

Requirements

• 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.
• 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 delivering positive client and provider experiences.
• Ability to adapt to changing priorities and evolving business needs.
• Demonstrated commitment to operational excellence and continuous improvement.

Nice To Haves

• Associate or Bachelor's degree preferred.
• Experience working with AI-enabled workflow tools, automation platforms, or operational technology solutions is a plus.
• Experience using claims management systems and workflow management platforms preferred.

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.

Benefits

• 401k plan with employer match
• flexible paid time off
• holidays
• parental leaves
• life and disability insurance
• health benefits including medical, dental, vision, and prescription drug coverage

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED