Senior Claims Lead – Facets BPM & Operations

UST; Taguig; On-site; PHP 7,538,000 - 10,050,000; Full time

Job summary

UST is seeking a Claims Lead for BPM (Facets Claims Operations) to oversee end-to-end claims delivery within a Facets environment for a U.S. healthcare payer. The role focuses on governance, workforce management, quality oversight, escalation handling, and SLA compliance.

The ideal candidate has deep experience in claims lifecycle, benefits interpretation, pricing methodologies, and system edits, with 8+ years in U.S. Healthcare Claims Operations and at least 2 years in a lead capacity.

Qualifications

• Graduate degree required.
• 8+ years in U.S. Healthcare Claims Operations.
• Minimum 2+ years in a Team Lead or Operations Lead role.
• Strong Facets expertise required.
• Blue Plan/BlueCard experience is a plus.

Responsibilities

• Oversee end-to-end claims delivery within Facets adjudication environment.
• Manage daily production, work allocation, and throughput across queues.
• Ensure KPIs, SLAs, and productivity targets are met.
• Lead governance, quality, and defect prevention initiatives.
• Drive process optimization and first-pass accuracy improvements.

Skills

Facets adjudication

Workflow management

SLA management

Leadership

Analytical skills

Education

Graduate degree

Tools

Facets

Job description

UST is seeking a Claims Lead for BPM (Facets Claims Operations) to oversee end-to-end claims delivery within a Facets environment for a U.S. healthcare payer. The role focuses on governance, workforce management, quality oversight, escalation handling, and SLA compliance.

The ideal candidate has deep experience in claims lifecycle, benefits interpretation, pricing methodologies, and system edits, with 8+ years in U.S. Healthcare Claims Operations and at least 2 years in a lead capacity.