Claims Operations Transformation Lead (FACETS)

UST; Seattle (WA); On-site; USD 63,000 - 95,000; Full time

Benefits offered by this job

Medical, Dental and Vision insurance

401(k) with employer matching

Paid vacation and sick leave

Job summary

UST is seeking a Claims Operations lead to act as the primary client-facing advisor, managing executive stakeholder relationships and governance for FACETS Claims Operations.

You will drive end-to-end transition, knowledge transfer, and the establishment of service delivery frameworks while overseeing adjudication operations to meet productivity, quality, and SLA targets. Collaboration across Enrollment, Provider Operations, and Technology is essential.

Qualifications

• 10+ years of Healthcare Payer Operations and BPM/BPO experience with 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.

Responsibilities

• Lead end-to-end transition and operational delivery of FACETS Claims Operations with knowledge transfer and readiness.
• Partner with client SMEs to define future-state operating models and service delivery frameworks.
• Drive transition planning, readiness assessments, and operational acceptance activities for smooth handoffs to delivery teams.
• Oversee FACETS claims adjudication operations ensuring productivity, quality, and SLA adherence.
• Establish governance, dashboards, metrics, and controls for ongoing visibility to stakeholders.
• Identify risks, gaps, dependencies, and improvement opportunities with mitigation plans for stability.
• Collaborate with Enrollment, Provider Operations, Configuration, Application Support, and Technology teams to drive process effectiveness.
• Lead continuous improvement, automation, and transformation to boost efficiency and customer outcomes.
• Provide leadership to onshore and offshore teams, fostering accountability and excellence.

Skills

FACETS

Claims Management

Healthcare Systems

Stakeholder Management

Job description

UST is seeking a Claims Operations lead to act as the primary client-facing advisor, managing executive stakeholder relationships and governance for FACETS Claims Operations.

You will drive end-to-end transition, knowledge transfer, and the establishment of service delivery frameworks while overseeing adjudication operations to meet productivity, quality, and SLA targets. Collaboration across Enrollment, Provider Operations, and Technology is essential.