Claim Operations Manager

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 Manager I, Claim Operations. The Claims Operations Manager I is responsible to develop and maintain metrics/reports/tools to support various claim initiatives and personnel. The Manager will provide execution and strategic expertise to support day to day inventory and claims initiatives' success. The Manager will service as an integral part of the leadership team to help strategically plan for growth and develop ways to increase optimal operational efficiencies and quality of claims processing. Ensuring targets, goals and client expectations are met or exceeded.

The Opportunity:

• Assess and manage claims inventory; track and manage inventory trends and proactively adjusts resource levers as needed to maximize productivity to meet inventory management goals
• Be solutions oriented; analyze data, proactively assesses business needs
• Apply subject matter expertise to the business of claims processing and operations.
• Manage and coach individual contributor performance and quality using quantitative and qualitative data.
• 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 knowledge of CMS and regulatory claims processing guidelines to drive compliance in HealthProof claims processing policies and procedures.
• Work with Business Analysts and Technical Writers to design and document workflows and business processes.
• Recommend strategies for attaining and exceeding claims operations SLAs.
• Recommend training assets and job aids to improve operational effectiveness.

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:

• A minimum of 7 years of health insurance claims experience with progressive leadership responsibilities
• An ability to independently direct the implementation of complex business projects.
• Working knowledge of other functions within insurance operations and shared services (benefits, enrolment, compliance, medical management, customer service etc.)
• Possesses an in-depth understanding of industry issues and opportunities and is able to share gained knowledge.
• Effective communications: ability to obtain clear information and remove ambiguity as needed to arrive at shared expectations.
• Capability to approach problems as challenges and deal with them constructively, promoting this approach with all team members.
• Well-developed organizational habits
• Experience in MS Word, Excel, PowerPoint, MS Visio
• An operating knowledge of Lean Six Sigma and or AGILE, 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 applicable law, UST provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

Role Location: Remote

Compensation Range: $70,000-$120,000

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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