Associate BPM Lead

7 days ago

Taguig, National Capital Region, Philippines UST Full time ₱900,000 - ₱1,200,000 per year

5 Openings

Taguig, Taguig City

Role description

The Provider Inquiry & Claims Specialist is responsible for accurately reviewing and resolving provider inquiries received through the ticketing system and support resolving inquiry activities in accordance with established guidelines and policies. This role requires strong analytical skills, attention to detail, and the ability to collaborate across teams to ensure timely and accurate provider support and claims processing.

Key Responsibilities:

  • Review, investigate, and resolve provider inquiries via the ticketing system (OneHub)
  • Assist providers by clarifying payment determinations, claim status, and policy-related queries
  • Route or coordinate requests with adjustment/claims team when correction or reprocessing is required
  • Analyze claims to determine accurate payment or denial decisions as per policy and benefits
  • Apply appropriate benefits, edits, and pricing guidelines, including physician contract pricing
  • Maintain thorough documentation and follow up on pending provider requests
  • Handle a high volume of repetitive tasks efficiently while maintaining accuracy and compliance
  • Continuously improve productivity and achieve required quality and SLA targets
  • Adapt quickly to system updates, process changes, and new learning requirements
  • Amenable to 6 months project-based/contract, onsite and nightshift

Preferred Skills & Experience

  • Experience in US Healthcare claim adjudication or provider inquiry handling
  • Working knowledge of HealthEdge, CFI, CFS, OneHub a strong advantage
  • Strong analytical and problem-solving skills with good written and verbal communication
Skills

US Healthcare Claim,Analytical,Communication,Healthedge/CFI/CFS/OneHub

About UST

UST is a global digital transformation solutions provider. For more than 20 years, UST has worked side by side with the world's best companies to make a real impact through transformation. Powered by technology, inspired by people and led by purpose, UST partners with their clients from design to operation. With deep domain expertise and a future-proof philosophy, UST embeds innovation and agility into their clients' organizations. With over 30,000 employees in 30 countries, UST builds for boundless impact—touching billions of lives in the process.

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