Role Description

At UST, we help the world’s best organizations grow and succeed through transformation. Bringing together the right talent, tools, and ideas, we work with our client to co-create lasting change. Together, with over 30,000 employees in 30+ countries, we build for boundless impact—touching billions of lives in the process. Visit us at .

Summary

UST is looking for….

Claims Lead - BPM Role Summary We are seeking a Claims Lead to manage Facets-based claims operations within a Business Process Management (BPM) setting supporting a US healthcare payer. The role will be responsible for end-to-end process delivery, operational governance, escalation management, workforce planning, quality oversight, process optimization, and SLA adherence, with preferred exposure to Claims workflows, BlueCard/shared administration, payment integrity controls, and claims governance.

Key Responsibilities Operations Management Own overall claims delivery within the Facets adjudication environment, including workflow orchestration and execution oversight. Manage daily production, work allocation, queue balancing, and operational throughput. Drive consistency in claims processing across complexity segments, ensuring adherence to defined productivity benchmarks.

Maintain control over inventory health, aging, throughput, and operational performance across multiple work queues. Monitor process KPIs, SLAs, and operational metrics to ensure business objectives are achieved. Escalation / Functional Oversight Serve as the primary functional lead for Facets claims processing, spanning Claims adjudication workflows, Benefit validation and pricing execution, and Member and Provider data dependencies.

Drive resolution of complex claim scenarios involving pricing discrepancies (fee schedule, case rate, institutional pricing logic), Benefits interpretation and configuration dependencies, Retro eligibility, and adjusted claims. Ensure alignment with Facets configurations, edits,



and system-driven outcomes influencing claim disposition. Collaborate with stakeholders to identify process gaps and implement corrective actions.

Governance / Quality Ensure adherence to coding standards, payment policies, payer edits, payment integrity expectations, and BPM governance frameworks. Lead quality governance through calibration sessions, audit reviews and validation, root cause analysis, and defect prevention initiatives. Ensure adherence to defined accuracy standards across financial outcomes, payment correctness, processing compliance, and operational excellence metrics.

Address systemic error drivers linked to pricing logic, configuration gaps, eligibility, or provider data issues. Drive continuous process improvement initiatives to enhance operational efficiency and first-pass accuracy while reducing rework.

Mandatory

Skills &

Competencies Strong expertise in Facets claims adjudication and workflow management. Deep understanding of claims lifecycle (intake to adjudication to adjustment), Benefits, Pricing, Payment Policies, System Edits, Pend Management, and Resolution Workflows. Strong knowledge of Business Process Management (BPM), operational governance, process optimization, and quality management practices. Ability to manage complex, exception-driven claims environments.

Experience in SLA-driven operations, stakeholder management, process governance, and offshore delivery models. Strong analytical, problem-solving, leadership, and communication skills.

Qualifications Graduate (Mandatory). 8+ years of experience in US Healthcare Claims Operations. Minimum 2+ years in Team Lead / Operations Lead capacity.

Strong





Facets expertise required; Blue Plan experience preferred.

Experience in managing BPM operations, operational excellence initiatives, and process improvement programs.

What You Need

BTech/ MCA/ BCA/Msc IT/Bsc IT

Required Skills

FACETS, Claims Management, Healthcare Systems, Benefits Administration

What You Need

What we believe

We’re proud to embrace the same values that have shaped UST 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 centre 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 honour our commitments and act with responsibility in all our relationships.

Equal Employment Opportunity Statement

UST is an Equal Opportunity Employer. We believe that no one should be discriminated against because of their differences, such as age, disability, ethnicity, gender, gender identity and expression, religion, or sexual orientation.

All employment decisions shall be made without regard to age, race, creed, colour, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

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

- To support and promote the values of UST.
- Comply with all Company policies and procedures

Skills FACETS, Claims Management, Healthcare Systems, Benefits Administration

📌 Lead I - BPM- Claim (Thiruvananthapuram)
🏢 UST
📍 Thiruvananthapuram