Document Retrieval Specialist

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.

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.

The Document Retrieval Specialist is responsible for supporting the medical claim review and audit process by proactively contacting healthcare providers to request, obtain, and manage billing documentation. This role serves as a key liaison between providers and internal teams, ensuring that required records are received in a timely manner to facilitate accurate claim evaluation and processing. The specialist is responsible for maintaining consistent follow-up on outstanding requests, uploading and organizing received documentation, and reviewing records for completeness, accuracy, and compliance with client requirements.

Success in this role requires strong organizational skills, attention to detail, effective communication, and the ability to manage multiple priorities while meeting established productivity and quality standards.

• Assist the nursing staff in the medical claim audit process by contacting healthcare providers to request and obtain billing documents via fax, mail, and email for claims processing.
• Receive and upload retrieved documents into designated systems, ensuring documents are properly indexed and associated with the correct claim.
• Review uploaded documentation for completeness, accuracy, and compliance with client and provider requirements, identifying and escalating discrepancies as appropriate.
• Organize and prioritize assigned claims daily and conduct timely follow-up on outstanding document requests.
• Accurately document outreach attempts, provider communications, request statuses, and other relevant information.
• Utilize document retrieval systems and related tools efficiently.
• Learn and process requests according to applicable provider and client requirements.
• Meet or exceed the Document Retrieval Performance Standards established by the Document Retrieval department.
• Maintain awareness of and adherence to Zelis standards regarding privacy and confidentiality.

• Previous healthcare, medical claims, billing, or customer service experience preferred.
• Knowledge of Microsoft Office Suite and web-based systems.
• Strong prioritizing & organizational skills.
• Excellent customer service & telephone skills.

Requires minimal daily supervision on day-to-day tasks but seeks guidance on more complex tasks;
Accountable for day-to-day tasks;
Able to follow…