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Associate BPM Lead
2 weeks ago
1 Opening
Taguig City
Role descriptionUST HealthProof partners with health plans to deliver integrated operations solutions. With over 4,000 employees worldwide, we focus on simplifying healthcare administration and ensuring equitable access.
Role Overview:
The Appeals and Grievances Analyst ensures cases are handled accurately and in compliance with CMS regulations. Key duties include processing end-to-end cases, preparing summaries, coordinating assignments, and ensuring timely completion. Analysts also document findings, recommend case resolutions, and participate in quality improvement and compliance initiatives.
Key Responsibilities:
- Process and document appeals and grievances following company and CMS guidelines
- Investigate cases, prepare summaries, and support operational excellence
- Assign and coordinate case review tasks
- Identify and escalate process or system issues
- Collaborate with IT for process improvements
- Participate in audits and compliance committees
Qualifications:
- Bachelor's degree required; Master's preferred (or equivalent experience)
- Certification in related field preferred
- Experience in grievances, appeals, and CMS regulations, especially with Medicare Advantage plans
- Knowledge of claims, authorizations, and industry rules
Skills:
- Strong analytical, organizational, and communication abilities
- Problem-solving and data analysis skills
- Ability to work under deadlines and communicate across departments
Appeals,Team Leading,Healthcare
About USTUST 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.
