Associate BPM Lead

2 days ago

Taguig, National Capital Region, Philippines UST Full time

1 Opening

Taguig City

Role description

UST 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
Skills

Appeals,Team Leading,Healthcare

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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