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) workplace 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 s

📌 Lead I (Thiruvananthapuram)
🏢 UST
📍 Thiruvananthapuram