ITS Claims Lead

Job Description

ITS Claims Lead

Lead II – BPM

Who We Are

UST HealthProof is a dynamic company with a mission to lower the cost of care and deliver the future of healthcare. Our consumer-centric approach gives our health plan customers a modern infrastructure and reduced administrative costs, helping to drive better business results for our customers — and better outcomes for our communities.

We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States. **

You Are**

UST HealthProof is looking for an Inter-Plan Teleprocessing System (ITS) Claims Operations Lead II who is responsible for managing the HealthProof BlueCard Host and Home Claims Operations staff and their daily work requirements. Leveraging metrics and forecasts, the ITS Claims Lead II prioritizes workload and resourcing to maximize operational production, reduce claims inventory, and address claims aging. The Lead will work collaboratively to facilitate the design, development, and implementation of policies, procedures, and practices in support of HealthProof’s BPaaS ITS claims operations. **

The Opportunity**

• Manage and coach individual contributor performance and quality using quantitative and qualitative data
• Assess and manage claims inventory; track and manage inventory trends and proactively adjust resource levers as needed to maximize productivity to meet inventory management goals and Blue Cross Blue Shield Association Service Level Agreements
• Create daily updates for the management team, flagging production rates, critical issues, and areas of escalation in real-time
• Be solutions-oriented; analyze data, proactively assess business needs, and adjust resourcing levels to provide the best claims operations performance while practicing fiscal responsibility
• Apply subject matter expertise to the business of claims processing and operations
• Independently identify and resolve team issues with appropriate escalation
• Train and coach staff and vendors on claims processes
• Motivate and lead team members in accordance with HealthProof values and objectives
• Proactively review and assess talent
• Use specialized knowledge of CMS and Blue Cross Blue Shield Association claims processing guidelines to drive compliance in HealthProof claims processing policies and procedures
• Work with Business Analysts and Technical Writers to design and document new joint operations workflows and business processes with BPaaS clients
• Use claims project metrics knowledge to understand the relevance of the project, collect/ collate claims project metrics and share it with the relevant stakeholders, understand and apply the tools used to track metrics
• Recommend strategies for attaining and exceeding claims operations SLAs
• Recommend training assets and job aids to improve operational effectiveness
• Assess current Operations capabilities and recommend process improvements

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. **

What You Need**

• Bachelor’s degree and/or equivalent experience
• 4+ years of overall experience in progressive roles in ITS claims operations and business process design
• A minimum of 2 years of supervisory experience in claims operations
• Knowledge of claims processing guidelines for both ITS and government programs (Medicare Advantage and Medicaid)
• The ability to adapt quickly to a fast-paced environment
• Excellent written and oral communication skills
• The ability to understand and speak Tech Jargon
• Ability to coach the team to reach their full potential
• Adaptability, flexibility, and a self-organized and highly energetic team player

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by local law, UST provides a reasonable range of compensation for roles that may be hired in California, Colorado, New York, or Washington as set forth below. **

Role Location: Remote

Compensation Range:** $50,000-$62,000

Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits. **

What We Believe**

We’re proud to embrace the same values that have shaped UST HealthProof since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone, to champion diversity and inclusion, and to place people at the center of everything we do. **

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 HealthProof 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, or status as a protected veteran.

UST HealthProof 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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