Associate BPM Lead

UST Taguig, National Capital Region, Philippines

2 days ago Be among the first 25 applicants

Role Description
UST is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members’ well-being.

Role Description
UST is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members’ well-being.
With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all. We have a strong global presence and a dedicated workforce spread across the world. Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.
As an Appeals & Grievances Analyst, you will manage and resolve appeals and grievances submitted by members, providers, and regulatory agencies. This role requires a deep understanding of Medicare Advantage regulations, client contracts, excellent analytical skills, and a commitment to ensuring compliance.

• Review and analyze appeals and grievances to determine appropriate resolutions
• Ensure compliance with CMS (Centers for Medicare & Medicaid Services) regulations and guidelines, and client specific rules
• Conduct thorough investigations, including gathering and reviewing medical records, provider documentation, and member information
• Prepare detailed case summaries and decision letters
• Communicate effectively with members, providers, and regulatory agencies to resolve issues.
• Maintain accurate and up-to-date records of all appeals and grievances
• Identify trends and provide recommendations for process improvements
• Collaborate with internal departments to ensure timely and accurate resolution of cases
• Ability to work in a fast-paced production environment
  

Qualifications

• Bachelor's degree in healthcare administration, nursing, or a related field an advantage but not required
• Minimum of 2 years of experience in Medicare Advantage or Medicare-related field such as Claims and/or UM.
• In-depth knowledge of CMS regulations and guidelines
• Strong analytical and problem-solving skills
• Excellent written and verbal communication skills
• Ability to work independently and as part of a team
• Strong attention to detail and organizational skills
• 2 years of appeals and grievances experience preferred
• Medical billing / coding knowledge an advantage
• Amenable to working nightshift
  

Skills
Healthcare,Medical Management,Business Process Seniority level

• Seniority level Entry level

Employment type

• Employment type Full-time

Job function

• Job function Other
• Industries IT Services and IT Consulting

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