Job Description
Senior Claims Specialist
Group Manager I – 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 a Senior Claims Specialist. This senior role will play a pivotal role in providing strategic guidance, analytical insights, and operational support to optimize the claims processes, enhance client satisfaction, and drive departmental efficiency. Your expertise will be instrumental in helping our organization achieve goals and maintain a high level of service excellence. **
The Opportunity**
- Utilize your extensive knowledge of claims processing to analyze, assess, and optimize the client's claims operations.
- Identify areas for process improvement and recommend strategies for enhancing claim processing efficiency and accuracy.
- Be the go-to expert in claim edits and the HRP (HealthRule Payor) processing system, offering insights into system configuration, rules, and best practices.
- Collaborate with the client to ensure that claim edits are effectively implemented and monitored to enforce desktop procedures and support regulatory requirements.
- Provide expert guidance and present data-driven recommendations to support executive decision-making.
- Monitor and enforce adherence to desktop procedures, company policies, and industry best practices.
- Stay updated on industry trends and best practices, sharing knowledge within the team.
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**
- Minimum of 10 years of health insurance claims experience
- HRP (Health Rules Payor) Claims Processing System, preferred
- Strong analytical, problem-solving, and data interpretation skills
- Excellent communication, and interpersonal abilities.
- Proficiency in data analysis tools and software (e.g., Excel, SQL, Visio, MS Word).
- Knowledge of health insurance regulations and industry standards.
- Ability to lead cross-functional teams and drive change initiatives.
- Working knowledge of other functions and shared services.
- Capability to approach problems as challenges and deal with them constructively; promoting this approach with all team members.
- A deep knowledge of Lean Six Sigma and or AGILE is preferred.
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:** $88,000-$132,000
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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