Sr. Director, Ideation Intelligence & Analytics

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

What You’ll Do

Analytical Opportunity Discovery

• Build and lead the analytical discovery capability supporting enterprise PI ideation.

• Apply advanced analytics, statistical methods, AI, anomaly detection, and pattern recognition to claims, provider, billing, reimbursement, clinical, dispute, and operational data to surface opportunities that existing rules and reporting do not reveal.

• Develop and test hypotheses about payment errors, billing behaviors, and provider patterns, and identify the populations, claim types, providers, services, and codes associated with each opportunity.

• Analyze cross-claim, longitudinal, provider-level, and population-level patterns, and establish methods that separate meaningful opportunities from noise and reduce false-positive discovery.

Partnership with Concept & Ideation

• Serve as the primary analytical partner to the Concept & Ideation team, translating findings into clear opportunity hypotheses for clinical, coding, reimbursement, and policy validation.

• Provide claims examples, population analysis, provider characteristics, and preliminary savings estimates, and continue testing assumptions, exclusions, and targeting during concept development.

• Establish analytical readiness criteria for moving an opportunity from exploratory discovery into formal concept development, and track concept outcomes so methods improve over time.

Opportunity Sizing & Analytical Validation

• Develop sizing methods covering addressable claims, frequency, potential savings, and expected yield, and provide the analytical inputs used to prioritize concept-development capacity.

• Evaluate precision, sensitivity, and false-positive risk, and support retrospective testing against historical claims before concepts advance to Product development.

• Assess how concepts may perform across client populations and where customization or scale constraints may arise.

• Provide analytical inputs to business cases, reconciling estimates with Finance, Strategy, and Product assumptions; PI Strategy & Transformation retains business-case governance.

AI & Advanced Analytics Innovation

• Identify and prototype uses of machine learning, generative AI, natural language processing, and advanced analytics that accelerate opportunity discovery.

• Partner with Technology, Product, and other key stakeholders on when promising methods should become scalable capabilities.

• Establish human validation, explainability, and quality controls for AI-assisted discovery, and evaluate model outputs for accuracy, stability, and potential bias or unsupported conclusions.

Closed-Loop Learning & Concept Performance

• Partner to evaluate how analytically derived concepts perform after deployment, including realization, hit rates, overturns, disputes, exclusions, and client variation.

• Use production outcomes to refine models, targeting, and sizing assumptions, learn from underperforming concepts, and identify opportunities to refine, expand, or retire existing concepts.

Cross-Functional Partnership

• Provide analytical evidence to the PI leadership team, and use their production findings, disputes, reviewer feedback, and performance insight to inform discovery.

• Partner with enterprise Data & Analytics and Technology on data access, platforms, governance, and advanced methods, and with clinical teams where findings need clinical interpretation.

Team Leadership & Capability Development

• Build, lead, and develop Payment Integrity analytics and intelligence with expertise across claims, reimbursement, coding, provider behavior, statistical methods, and AI.

• Establish common methodologies, documentation, validation approaches, and quality standards, and develop analysts who turn complex data into actionable payment accuracy hypotheses rather than reporting alone.

• Foster a culture of experimentation, analytical rigor, and responsible AI use, and help build the capabilities to establish advanced Payment Integrity analytics.

What you'll bring to Zelis:

Required

• Bachelor’s degree in Data Science, Statistics, Analytics/Healthcare Analytics, or a related discipline; equivalent experience considered.

• 12+ years of progressive experience in healthcare, Payment Integrity, claims analytics, data science, or advanced analytics.

• Deep experience with healthcare claims data and with using advanced analytics to identify previously unknown patterns, anomalies, or savings opportunities.

• Strong understanding of healthcare reimbursement, billing, coding, provider behavior, and payer economics.

• Demonstrated ability to develop and test hypotheses, size value, and communicate findings to clinical, business, Product, and executive audiences, distinguishing statistically interesting findings from defensible opportunities.

• Strong cross-functional influence and executive communication skills in complex matrixed organizations.

Preferred

• Experience in Payment Integrity or related payment disciplines.

• Experience with anomaly detection, provider profiling, predictive modeling, machine learning, or AI-enabled claims analysis, including prototypes that transition to Product or Technology for scale.

• Familiarity with responsible AI, model validation, explainability, and human-in-the-loop methods.

• Advanced degree in a relevant discipline.

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-office work and activities vary based on work and team objectives in accordance with Company policies.

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.

Base Salary Range

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.

Zelis’ full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees’ health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We welcome applicants from all backgrounds and encourage you to apply even if you don’t meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.