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Lead Claims Examiner (Lead I - BPM) Job in Grove City, Ohio US

Lead Claims Examiner (Lead I - BPM)


Posted: 7/30/2021 - Expires: 10/28/2021

Job ID: 230073387


Job Description

Claims Team Lead

UST HealthProof is looking for a highly energetic and collaborative Claims Team Lead with 5-7+ years of operation experience, out of which 2+ years in supervisory role. This role will report into the Operations Manager or as designated by the Director of Operations for Healthcare Platform Solutions. Candidate should have Excellent written and verbal communication skills and ability to liaise with client organizations and multiple stakeholders to be successful in this role.

The primary objective of The Claims Leader is to implement policies and procedures to foster an environment of excellence in servicing UST HealthProof Healthcare Customers. This includes leading and managing a team of 12-15 claims examiners, adjusters, extensive interaction with client organization and multiple stakeholders, delivering a high-quality claims operation meeting and exceeding all service level agreements and KPIs, driving operational excellence and building competencies for delivery.

As a Claims Team Lead at UST HealthProof, this is your opportunity to

*  Be responsible for directly managing a staff of 15-20 associates

*  Be responsible for day to day interaction with client organization to help run a high-quality claims operation

*  Implement a daily operations governance process to analyze, prioritize and deliver daily, weekly, monthly targets

*  Collaborate with the client in creating claims reports (inventory, production, productivity, priority and forecasting) to meet and exceed all production Service Level Agreements (SLA)

*  Collaborate with client and Audit team to understand and establish a robust Quality program - to measure, analyze, root cause analysis and take and take Corrective Actions as needed

*  Establish a transparent communication plan with client Claims leadership to address issues, concerns and take preventive measures to avoid service quality issues

*  Ensure setting smart goals for teams and provide regular feedback, appraisal and coaching to ensure performance

*  Be responsible for managing personnel matters like attendance, holidays, PTO, sick days, approve hours for payroll, shift timings etc. with the prime objective of meeting and exceeding customer deliverables

*  Collaborate with Subject Matter Experts (SMEs) to ensure that Standard Operating Procedures (SOPs) are adequate for the needs of the operations teams, review them periodically for updates and enhancements and ensure version control and client approvals

*  Undertake special project(s) as defined a deemed necessary by the UST management teams

*  Participate in meetings and project activities outside of the primary location at locations determined by UST management team

You bring:

*  Excellent comprehension and communication skill (verbal and written) within the organization and with clients

*  5-7+ years of operation experience, out of which 2+ years in supervisory role

*  Must have some background in administration and preferably some experience in healthcare including but not limited to medical coding, transcription, doctor's office, billing, account receivable on claims processing experience preferred

*  Some experience in outsourcing operations or service industry preferred

*  High proficiency in using MS Excel and PowerPoint

*  Good understanding and ability to analyze claims data and report, SLA, KPI, operations report and present findings in a structured way

*  Excellent People skill - ability to build and motivate a large operations team of up-to 20 associates

*  Some ability to train and guide the teams thru changes in processes and operating instruction

For this role, we value:

*  The ability to adapt quickly to a fast-paced environment

*  Excellent written and oral communication skills

*  Ability to coach the team to reach their full potential

*  Ability to gel with the team well and build a self-organized and highly energetic team

Overall Experience level: 5-7+ years of operation experience, out of which 2+ years in supervisory role

Location: This position will be based in Sidney, NE; Columbus, OH; Pittsburgh, PA

UST Global celebrates diversity and inclusion. We are an Equal Employment Opportunity employer. We welcome candidates to apply for employment from diverse backgrounds and believe your unique perspective adds to the richness of our company culture. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

Job Summary

Employment Type:
Full Time Employee
Job type:
Federal Contractor
Skill Based Partner:
Education Level:
No school grade completed
Work Days:
Mon, Tue, Wed, Thu, Fri
Job Reference Code
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