Claims Operations (Facets) Lead

UST; Bellevue (WA); On-site; USD 83,000 - 125,000; Full time

Job summary

UST is seeking a Claims Operations (Facets) Lead to drive the end-to-end transition and operational delivery of Facets Claims Operations from Washington state. You will ensure knowledge transfer, readiness, stabilization, and a seamless handoff to delivery teams.

You will oversee adjudication operations, establish governance processes, performance metrics, and dashboards, and collaborate with Enrollment, Provider Operations, Configuration, Application Support, and Technology teams to improve

Qualifications

• 10+ years of Healthcare Payer Operations experience with deep expertise in Facets Claims processing and adjudication.
• Proven experience leading large-scale transition, transformation, and managed services engagements.
• Strong understanding of Commercial, Medicare, Medicaid, and Government Programs claims operations.
• Demonstrated success managing client relationships, operational governance, service delivery, and cross-functional teams.
• Excellent communication, stakeholder management, and leadership skills.

Responsibilities

• Act as the primary client-facing lead and trusted advisor for Claims Operations, managing executive stakeholder relationships, governance forums, risk reviews, and operational decision-making.
• Partner with client SMEs and business leaders to assess current-state operations, define future-state operating models, and establish service delivery frameworks.
• Drive transition planning, knowledge transfer execution, readiness assessments, and operational acceptance activities to ensure a successful handoff to delivery teams.
• Oversee Facets claims adjudication operations, ensuring adherence to productivity, quality, accuracy, turnaround time, and SLA commitments.
• Establish governance processes, performance metrics, reporting dashboards, and controls to monitor operational performance and deliver continuous visibility to stakeholders.
• Identify operational risks, process gaps, dependencies, and improvement opportunities, implementing mitigation plans and corrective actions to ensure delivery stability.
• Collaborate with cross-functional teams including Enrollment, Provider Operations, Configuration, Application Support, and Technology teams to drive end-to-end process effectiveness.
• Lead continuous improvement, automation, and transformation initiatives to enhance operational efficiency, quality, customer experience, and business outcomes.
• Provide leadership, coaching, and direction to onshore and offshore operations teams, fostering a culture of accountability, collaboration, and operational excellence.
• Support workforce planning, capacity management, forecasting, and resource optimization to align with client demand and business objectives.
• Ensure compliance with healthcare payer regulations, client policies, audit requirements, and operational governance standards.

Skills

FACETS

Claims Management

Healthcare Systems

Stakeholder Management

Job description

Claims Operations (Facets) Lead

Manager I - HealthPlan

Role description

Who We Are:

Born digital, UST transforms lives through the power of technology. We walk alongside our clients and partners, embedding innovation and agility into everything they do. We help them create transformative experiences and human-centered solutions for a better world.

UST is a mission-driven group of 29,000+ practical problem solvers and creative thinkers in more than 30 countries. Our entrepreneurial teams are empowered to innovate, act nimbly, and create a lasting and sustainable impact for our clients, their customers, and the communities in which we live.

With us, you'll create a boundless impact that transforms your career-and the lives of people across the world.

Visit us at UST.com.

You Are:

UST is searching for a Claims Operations (Facets) Lead who will lead the end-to-end transition and operational delivery of Facets Claims Operations, ensuring successful knowledge acquisition, operational readiness, stabilization, and seamless transition to steady-state support.

The opportunity:

• Act as the primary client-facing lead and trusted advisor for Claims Operations, managing executive stakeholder relationships, governance forums, risk reviews, and operational decision-making.
• Partner with client SMEs and business leaders to assess current-state operations, define future-state operating models, and establish service delivery frameworks.
• Drive transition planning, knowledge transfer execution, readiness assessments, and operational acceptance activities to ensure a successful handoff to delivery teams.
• Oversee Facets claims adjudication operations, ensuring adherence to productivity, quality, accuracy, turnaround time, and SLA commitments.
• Establish governance processes, performance metrics, reporting dashboards, and controls to monitor operational performance and deliver continuous visibility to stakeholders.
• Identify operational risks, process gaps, dependencies, and improvement opportunities, implementing mitigation plans and corrective actions to ensure delivery stability.
• Collaborate with cross-functional teams including Enrollment, Provider Operations, Configuration, Application Support, and Technology teams to drive end-to-end process effectiveness.
• Lead continuous improvement, automation, and transformation initiatives to enhance operational efficiency, quality, customer experience, and business outcomes.
• Provide leadership, coaching, and direction to onshore and offshore operations teams, fostering a culture of accountability, collaboration, and operational excellence.
• Support workforce planning, capacity management, forecasting, and resource optimization to align with client demand and business objectives.
• Ensure compliance with healthcare payer regulations, client policies, audit requirements, and operational governance standards.

What you need:

• 10+ years of Healthcare Payer Operations experience with deep expertise in Facets Claims processing and adjudication.
• Proven experience leading large-scale transition, transformation, and managed services engagements.
• Strong understanding of Commercial, Medicare, Medicaid, and Government Programs claims operations.
• Demonstrated success managing client relationships, operational governance, service delivery, and cross-functional teams.
• Excellent communication, stakeholder management, and leadership skills.

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

Role Location: Washington

Compensation Range

$83,000-$125,000

Benefits

Full-time, regular employees accrue a minimum of 10 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave and jury duty. They are eligible to participate in the Company's 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance, as well as the following Company-paid Employee Only benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses as allowable under IRS guidelines. Benefits offerings vary in Puerto Rico.

Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company's 401(k) Retirement Plan with employer matching.

Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company's 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance.

Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year).

All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws.

What we believe:

We proudly embrace the values that have shaped UST since day one. We build our culture of Humility, Humanity, and Integrity. These values inspire us to nurture a people-first, human centric culture that fosters diversity, prioritizes sustainable solutions, and keeps our people and clients at the forefront of all decisions.

Humility:

We will listen, learn, be empathetic and help selflessly in our interactions with everyone.

Humanity:

Through business, we will better the lives of those less fortunate than ourselves.

Integrity:

We honor our commitments and act with responsibility in all our relationships.

Equal Employment Opportunity Statement

UST is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and "fair chance" ordinances.

UST reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

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Skills

FACETS, Claims Management, Healthcare Systems, Stakeholder Management