Zelis
- Company typePrivate
- Founded1995
- HeadquartersBedminster, United States
- Headcount1,001–5,000
- GTM typeB2B
- OfferingSoftware
Zelis firmographics
Firmographics- Name
- Zelis
- Legal name
- Zelis Healthcare
- Website
- https://zelis.com
- Company type
- Private
- Founded year
- 1995
- Operating status
- Operating
- Headcount range
- 1,001–5,000 employees
- Ownership category
- akta.pro rank
Where Zelis is headquartered
LocationHeadquarters
- HQ city
- Bedminster
- HQ country
- United States
- HQ region
- North America
Offices6 records
Markets served
Zelis business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure
Revenue model
- Healthcare Technology Solutions: Zelis generates revenue through providing integrated healthcare financial technology solutions to payers, providers, and third-party administrators. The company offers a platform of solutions including network solutions, payment integrity, claims pricing, payments optimization, and member engagement. Revenue is derived from transaction-based pricing, subscription arrangements, and performance-based pricing for cost containment services.
- Payment Processing Services: Revenue from electronic payment processing, including ACH, virtual credit cards, and digital payment solutions through the ZAPP platform. Fees are based on payment volume and transaction types processed.
- Claims Cost Management: Revenue generated from claims editing, repricing, and payment integrity solutions that help payers reduce claim costs. Pricing typically involves a percentage of savings captured or transaction fees per claim processed.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Transaction based/ take rate | Multi-year contract | Enterprise payer pricing based on claims volume and solution bundle |
| Transaction based/ take rate | Pay-as-you-go | Provider payment processing fees |
Go-to-market motion1 record
Distribution channels5 records
Marketing channels7 records
Zelis product offering
Product offeringCore offering
Zelis is a healthcare financial technology company that provides an integrated platform of network solutions, claims pricing, payment integrity, payments optimization, and member engagement to payers, providers, and third-party administrators. The company combines AI-powered automation with expert human oversight to process claims, optimize reimbursement, and deliver electronic payments across the healthcare financial ecosystem, serving 770+ payers and 850,000+ providers.
Product overview
Zelis is a healthcare technology company offering a modular platform-plus-modules architecture for healthcare financial optimization. The core platform consists of the Zelis Intelligent Pricing Platform (ZIPP) which unifies claims pricing and payment integrity, and ZAPP (Zelis Advanced Payments Platform) which handles payments and communications. These platforms integrate multiple specialized solutions including Network Solutions with Network360 analytics, In-Network Pricing, Out-of-Network Solutions with Expert Negotiations and Market-Based Pricing, Payment Integrity with Expert Claims Review, Member Engagement solutions (S365, SmartShopper, Mobile Member Connect), and Claims Communications. The product portfolio serves payers (health plans, TPAs, dental payers, P&C carriers), providers (health systems, hospitals, medical and dental practices), and brokers/consultants across the healthcare financial ecosystem.
Differentiator
Problem solved
Functional benefit
Brands
- ZAPP (Zelis Advanced Payments Platform): Modern healthcare payments solution that unifies claims payments, data and communications for providers and members.
- ZIPP (Zelis Intelligent Pricing Platform)
- Network360
- S365
- SmartShopper
- Mobile Member Connect
- NSA Claim Advantage
- Zelis Expert Claims Review
- Open Access Pricing
- Compass Connect
- ZAPP Edge
Products and services
- Zelis Intelligent Pricing Platform (ZIPP) A modular, end-to-end ecosystem that unifies claims pricing and payment integrity into a single seamless experience. Powered by advanced AI and expert human oversight, ZIPP intelligently routes and reviews every claim optimizing for accuracy, savings, and compliance. Designed for healthcare payers.
- ZAPP (Zelis Advanced Payments Platform) Modern healthcare payments platform that unifies claims payments, data and communications for providers and members. Brings together all payments, communications, providers, and members to improve efficiency and enhance the payment experience for payers and providers.
- ZAPP Edge Provider payments solution offering direct deposit via ACH, virtual credit cards, and single portal access to payments and data from 550+ payers. Designed for healthcare providers (health systems, hospitals, medical practices, dental practices).
- NSA Claim Advantage AI-native No Surprises Act dispute management solution that transforms NSA outcomes with real-time case visibility, data-backed negotiation, defensible pricing, and embedded expert oversight to reduce IDR escalation and improve win rates. Built for health insurers.
- Network Solutions Suite of solutions to build, maintain, and optimize competitive, high-performing networks including Network Foundations, Network Performance benchmarking, and Primary/Wrap/Supplemental Networks. Designed for health plans, TPAs, and brokers.
- Out-of-Network Solutions Comprehensive suite for managing out-of-network costs including Expert Negotiations, Market-Based Pricing, Specialty Networks, State-Based Pricing, NSA solutions, and Member Bill Support. Designed for payers managing out-of-network claims.
- Payment Integrity Suite of claims editing and bill review solutions ensuring accurate payments before pay, including Expert Claims Review and Claims Editing with clinical coding policy expertise. Designed for healthcare payers.
- Member Engagement Comprehensive member engagement platform empowering members to navigate finding care at affordable cost through enrollment tools, ID cards, cost transparency tools, provider search, and personalized support. Designed for health plans and TPAs.
- Price Transparency Solutions Solutions helping payers stay compliant with Transparency in Coverage (TiC) federal rules through MRF management, S365 provider search, and comprehensive claims data for precise pricing information. Designed for health plans.
- Reference-Based Pricing Network replacement solution setting maximum reimbursement amounts using pre-defined prices to control rising healthcare costs while empowering members. Designed for self-funded employer health plans and TPAs.
- ZAPP for Property and Casualty Payment and communications solution for property and casualty payers managing medical, B2B, B2C and indemnity payments across Workers' Comp, Auto and beyond. Designed for P&C insurers.
- In-Network Pricing Claims pricing and contract modeling solution that leverages technology to analyze plans, measure contract performance, and price claims with transparency and accuracy in under 1 second. Designed for healthcare payers.
Quantifiable outcome
- $727M in savings for AmeriBen clients in 2021 alone
- +9 more outcomes
Companies that use Zelis
Customer profileNamed customers5 records
Segments8 records
Ideal customer profiles5 records
Zelis technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Integration7 records
AI capability9 records
Feature10 records
Zelis partnerships and signals
Strategic signalPartnerships
Four partnerships are on record, tiered core.
- Amazon Web Services (AWS)coreZelis selected AWS as its preferred cloud provider, migrating workloads to AWS and deploying AI services including Amazon Bedrock, Amazon Quick, and Kiro. The partnership aims to enhance healthcare payments and claims pricing solutions through intelligent automation while maintaining healthcare compliance and security standards.
- Jopari SolutionscorePartnership expanded digital payments for property and casualty insurers by integrating Zelis ZAPP Edge provider payments solution into Jopari's electronic billing and payment platform. The partnership aims to accelerate ACH payments to medical providers, reduce reliance on paper and manual processes, and improve visibility across reimbursement workflows.
- SnowflakecoreZelis partnered with Snowflake to migrate its data foundation from SQL Server to Snowflake AI Data Cloud, deploying 20+ production agents providing near real-time answers and democratized data insights across hundreds of users, reducing workloads on the core data team.
- Duck Creek TechnologiescoreStrategic partnership expanding Zelis ZAPP platform into property and casualty insurance sector. Integration aims to modernize claims and premium payments, enabling faster and more efficient transactions for insurers, providers, and policyholders with significantly shortened implementation timeline.
Scale indicators17 records
Recent moves9 records
Expansion highlights6 records
Zelis competitors and assessment
Company assessmentDirect peers
- Waystar: Healthcare revenue cycle and payments technology platform serving providers and payers with claims management, payment processing, and patient engagement. Zelis's CEO Amanda Eisel previously scaled Waystar, and the two companies compete directly in healthcare payment orchestration and claims pricing.
- MultiPlan: Specializes in healthcare cost containment through out-of-network repricing, reference-based pricing, and claims cost management — directly mirroring Zelis's OON Solutions and Open Access Pricing product lines. Both serve commercial payers, TPAs, and P&C carriers.
- Cotiviti: Payment integrity and healthcare analytics vendor serving payers with claims editing, DRG validation, subrogation, and clinical audit capabilities. Highly comparable to Zelis's Expert Claims Review and payment integrity suite.
- Availity: Operating the nation's largest healthcare information network connecting payers and providers for eligibility, claims, and prior authorization. Comparable to Zelis in serving as the interoperability backbone between payers and providers, especially in medical and dental workflows.
- InstaMed (JPMorgan): Healthcare payments network now within JPMorgan, focused on connecting payers, providers, and members for electronic payments and remittance. Direct overlap with ZAPP and ZAPP Edge on the provider payments and remittance aggregation layer.
Broad incumbents
- Change Healthcare (Optum): Now operating within UnitedHealth's Optum, Change Healthcare is the largest healthcare information network in the US, offering claims processing, payment integrity, and price transparency at massive scale. It is the broad incumbent against which Zelis competes across claims pricing and payment orchestration.
Emerging players
- Health Catalyst: Healthcare data and analytics platform offering provider-facing analytics, payer analytics, and population health. Overlaps with Zelis's Network360 analytics and Rivet acquisition on the analytics and decision-support layer of healthcare finance.
- Edifecs: Healthcare data interoperability and value-based care analytics vendor offering EDI normalization, claims processing, and risk adjustment. Comparable to Zelis in the data integration and clinical/claims interoperability layer.
- Cedar: Patient-facing healthcare billing and payments experience platform. Adjacent to Zelis's Mobile Member Connect and SmartShopper in addressing the member/patient financial experience, but focuses on the patient billing side rather than payer-provider interchanges.
Others
- Duck Creek Technologies: P&C insurance core systems vendor that Zelis strategically partners with to extend ZAPP into property and casualty. Partnered (not competing) — included because the integration is one of Zelis's most strategically important distribution channels.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat7 records
Key risks5 records
Key highlights7 records
Customer concentration
Zelis social profiles
Digital presenceZelis compliance and trust
Trust signalCompliance5 records
Zelis financial estimates
Financial estimateRevenue estimate
Valuation estimate
Zelis leadership team
Management profileNumber of profiles
Profiles11 records
Zelis subsidiaries and ownership
Company hierarchySubsidiaries14 records
Zelis funding detail
Funding detailFunding overview
Funding rounds3 records
Investors7 records
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Zelis M&A and investment
M&A and investmentM&A10 records
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Zelis
What does Zelis do?
Zelis is a healthcare financial technology company that provides an integrated platform of network solutions, claims pricing, payment integrity, payments optimization, and member engagement to payers, providers, and third-party administrators. The company combines AI-powered automation with expert human oversight to process claims, optimize reimbursement, and deliver electronic payments across the healthcare financial ecosystem, serving 770+ payers and 850,000+ providers.
Is Zelis a public or private company?
Zelis is a private company. It is classified as private equity controlled and is currently operating.
When was Zelis founded?
Zelis was founded in 1995. It employs 1,001 to 5,000 people.
Where is Zelis based?
Zelis is headquartered in Bedminster, United States, in the North America region.
How does Zelis make money?
Three revenue lines are on record. Healthcare Technology Solutions are the primary driver. The others are payment Processing Services and claims Cost Management.
Who are Zelis's main competitors?
Direct peers on record are Waystar, MultiPlan, Cotiviti, Availity and InstaMed (JPMorgan). Change Healthcare (Optum) is listed as a broad incumbent. Emerging players are Health Catalyst, Edifecs and Cedar. Duck Creek Technologies is listed as an others.
Does Zelis have an API?
Yes. Zelis offers an API Marketplace (marketplace.zelis.com) and API-based integrations for provider search, price transparency, and payment workflows. The provider search solution (S365) integrates via API into member portals. ZIPP supports API, EDI, or portal integration for repricing claims. Provider Nexus offers agile API for standardizing provider information. ZAPP Edge supports data delivery via API to clearinghouses or practice management systems. Developer documentation is at marketplace.zelis.com.