Sr. Director, Claims Pricing

Senior Director, Claims Pricing & Revenue

At Zelis, we Get Stuff Done. So, let's get to it!

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.

Position Overview

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.

What You Will Do:

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…