Senior Claims Operations Lead – Facets & SLA Excellence

UST; Taguig; On-site; PHP 1,800,000 - 2,400,000; Full time

Job summary

UST is seeking a Claims Lead to oversee end-to-end claims operations within a BPM environment for a U.S. healthcare payer. You will drive governance, workforce management, quality oversight, escalation handling, and SLA compliance in a Facets-driven setting.

The ideal candidate has strong leadership and deep experience in Facets claims adjudication, with a track record of optimizing claims processes and offshore delivery models to ensure accuracy and efficiency.

Qualifications

• Graduate degree required.
• 8+ years of experience in U.S. healthcare claims operations.
• Minimum 2+ years in a Team Lead or Operations Lead role.
• Strong Facets expertise is required.
• Experience with offshore delivery models is a plus.

Responsibilities

• Lead end-to-end claims delivery within the Facets adjudication environment.
• Manage daily production, work allocation, workload balancing and throughput.
• Monitor KPIs, SLAs, and productivity across queues.
• Drive consistency and efficiency in claims processing activities.
• Oversight of governance, quality, calibration, root-cause analysis, and defect prevention.

Skills

Facets adjudication

Workflow management

SLA management

Leadership

Offshore delivery

Education

Graduate degree

Job description

UST is seeking a Claims Lead to oversee end-to-end claims operations within a BPM environment for a U.S. healthcare payer. You will drive governance, workforce management, quality oversight, escalation handling, and SLA compliance in a Facets-driven setting.

The ideal candidate has strong leadership and deep experience in Facets claims adjudication, with a track record of optimizing claims processes and offshore delivery models to ensure accuracy and efficiency.