Senior BPM Lead

2 days ago

Taguig, National Capital Region, Philippines UST USource Full time

This role supports the Appeals and Grievances Department by assisting with regulatory and client reporting, audit monitoring, and compliance maintenance (e.g., CMS, Medicare Advantage, Prescription Drug requirements). They will collaborate with business areas to identify requirements, assess risks, and recommend compliant solutions; act as a subject matter expert on reporting regulations, audit protocols, and related training; and respond to compliance inquiries (e.g., HPMS reporting, regulatory and data validation audits).

Responsibilities:

  • Educates staff in managed care as it relates to department programs, processes, and systems
  • Leads preparation for regulatory reporting and audit activity and A&G-related compliance programs
  • Leads cross functional teams comprised of various internal customers and client resources
  • Lead complex development initiatives. Manages teams and ensure that project resources are utilized in an effective and efficient manner. Ensure project goals are met or exceeded via the facilitation and resolution of barriers prohibiting the progress on projects
  • Recommends and implements process changes to increase project execution performance
  • Leads preparation for regulatory reporting and /or audit activity and A&G-related compliance training programs
  • Partners with, and influences as necessary, subject matter experts
  • Provides assistance and mentors staff
  • Reviews system and tools to ensure quality and efficient implementation of development and enhancement efforts

Qualifications:

  • Bachelor's degree in a related field required. Certification or progress toward certification, such as Compliance Certification Board (CCB), is highly preferred and encouraged
  • Minimum of 5 years' experience in related healthcare field, Medicare Advantage preferred which may include experience in Appeals and Grievances, claims, compliance and/or audit
  • Strong analytical, planning, problem solving, verbal, and written skills to communicate complex ideas
  • Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.)
  • Ability to work independently, within a team environment, and communicate effectively with employees and clients at all levels
  • Flexibility and ease with changing tasks and priorities
  • Proven problem-solving skills and ability to translate knowledge to corporate departments
  • Strong communication skills are required to understand, interpret, and communicate ideas
  • Strong analytical, organizational, planning, and problem-solving skills
  • Ability to effectively interface with employees at all levels
  • Ability to define problems, collect data, establish facts, and draw valid conclusions
  • Demonstrated track record of generating results and having an impact on organizations
  • Strong focus and drive to serve the customer
  • Ability to work in a high-paced environment
  • Ability to consistently meet deadlines

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