Claims Lead, Facets & BPM Operations

UST USource; Pateros; On-site; PHP 1,200,000 - 1,800,000; Full time

Job summary

UST USource in Philippines seeks a Claims Lead to oversee end-to-end BPM operations for U.S. healthcare claims. You will drive delivery, governance, workforce management, quality oversight, escalation handling, and SLA compliance in a Facets-enabled environment.

You will mentor teams, optimize processes, ensure coding standards and payer edits alignment, and partner with stakeholders to close gaps. The role requires 8+ years in U.S.

Qualifications

• Strong expertise in Facets claims adjudication and workflow management.

Responsibilities

• Lead end-to-end claims delivery within the Facets adjudication environment.
• Monitor production, workload balancing, and throughput across queues.
• Ensure adherence to KPIs, SLAs, and productivity targets.
• Drive continuous improvement to reduce rework and improve first-pass accuracy.

Skills

Facets adjudication

Workflow management

SLA management

Leadership

Analytical skills

Education

Graduate degree

Tools

Facets system

Job description

UST USource in Philippines seeks a Claims Lead to oversee end-to-end BPM operations for U.S. healthcare claims. You will drive delivery, governance, workforce management, quality oversight, escalation handling, and SLA compliance in a Facets-enabled environment.

You will mentor teams, optimize processes, ensure coding standards and payer edits alignment, and partner with stakeholders to close gaps. The role requires 8+ years in U.S.