Claims Lead, Facets BPM Operations — Drive Efficiency

UST USource; Pateros; On-site; PHP 4,711,000 - 6,595,000; Full time

Job summary

UST USource is seeking a Claims Lead for BPM (Facets Claims Operations) to oversee end-to-end claims delivery within a Facets environment. The role emphasizes governance, workforce management, quality oversight, and SLA adherence across multiple queues to drive efficiency and accuracy.

The ideal candidate will have a graduate degree and 8+ years in U.S. Healthcare Claims Operations, with proven leadership and offshore delivery experience.

Qualifications

• Strong expertise in Facets claims adjudication and workflow management.
• Deep understanding of claims lifecycle, benefits administration, pricing methodologies, and payment policies.
• Experience managing SLA-driven operations and offshore delivery models.

Responsibilities

• Lead end-to-end claims delivery within the Facets adjudication environment.
• Manage daily production, work allocation, workload balancing, and throughput.
• Monitor inventory, aging, productivity, and operational performance across queues.
• Ensure adherence to KPIs, SLAs, and productivity targets.
• Drive consistency and efficiency in claims processing activities.

Skills

Facets adjudication

Workflow management

SLA governance

Leadership

Communication

Education

Graduate degree

Job description

UST USource is seeking a Claims Lead for BPM (Facets Claims Operations) to oversee end-to-end claims delivery within a Facets environment. The role emphasizes governance, workforce management, quality oversight, and SLA adherence across multiple queues to drive efficiency and accuracy.

The ideal candidate will have a graduate degree and 8+ years in U.S. Healthcare Claims Operations, with proven leadership and offshore delivery experience.