usource jobs in Manila

UST USource in Metro Manila is seeking a customer service professional to respond to inquiries about insurance benefits, claims, and provider contracts. You will analyze issues, document customer data, and collaborate with internal teams to resolve requests efficiently.The role focuses on maintaining accurate records, building relationships with customers,...

UST USource is seeking a Utilization Management (UM) Quality Assurance Nurse to support quality improvement through audits, performance analysis, and ensuring compliance with UM policies and procedures. The role collaborates with leadership to evaluate performance, develop educational materials, support system implementations, and contribute to continuous...

UST USource is seeking a Provider Data Management Analyst to review, validate, and maintain accurate provider information within our BPM environment in Manila. You will support outreach verification, returned mail handling, credentialing record updates, and PIMS claim-related setup, while meeting quality, productivity, and SLA targets.The successful...

UST USource in Philippines seeks a Claims Lead to oversee end-to-end BPM operations for U.S. healthcare claims. You will drive delivery, governance, workforce management, quality oversight, escalation handling, and SLA compliance in a Facets-enabled environment.You will mentor teams, optimize processes, ensure coding standards and payer edits alignment, and...

UST USource in Metro Manila is seeking a Provider Data Validation Specialist to review and correct healthcare provider information, ensuring accuracy and compliance with SLAs and process guidelines.You will validate demographics, credentials, network status, and payment details; update records; perform QA checks; and escalate complex cases while...

UST USource is seeking a Healthcare Inquiries Associate to review, investigate, and resolve provider questions related to claims, eligibility, benefits, authorizations, denials, and payments. The role emphasizes accurate, timely, and compliant responses to maintain service levels and quality standards.You will work across payer systems, document actions, and...

Job Description: Utilization Management (UM) Quality Assurance NurseJob SummaryThe Utilization Management (UM) Quality Assurance Nurse is responsible for supporting quality improvement initiatives by conducting comprehensive audits, analyzing operational processes, identifying trends and opportunities for improvement, and ensuring compliance with utilization...

The Provider Data Management (PDM) Analyst is responsible for reviewing, validating, updating, and maintaining accurate provider information within a Business Process Management (BPM) environment according to approved Premera processes and procedures. The role supports outreach verification, returned mail, credentialing record updates, and PIMS claim-related...

Key Responsibilities: Respond to customer inquiries via telephone and written correspondence, providing accurate and comprehensive information about insurance benefits, claims, and provider contracts Analyze customer issues and deliver effective solutions promptly and professionally Retrieve and document customer information, activities, and changes...

Claims Lead – BPM (Facets Claims Operations) Role Summary The Claims Lead will oversee end-to-end claims operations within a Business Process Management (BPM) environment supporting a U.S. healthcare payer. This role is responsible for operational delivery, governance, workforce management, quality oversight, escalation management, process optimization,...

Responsible for reviewing, validating, and correcting healthcare provider information as part of BPM operations. The role focuses on maintaining accurate provider data, meeting defined quality and productivity targets, and completing assigned activities within established SLAs and process guidelines.Key Roles and ResponsibilitiesProvider Data Validation:...

Job Summary Responsible for reviewing, investigating, and resolving healthcare provider inquiries related to claims, eligibility, benefits, authorizations, denials, and payments. Ensures accurate, timely, and professional responses while meeting service level agreements, quality standards, and compliance requirements. Responsibilities Review and investigate...

The Risk Adjustment HCC Coder is responsible for accurately reviewing and assigning ICD-10-CM diagnosis codes that map to Medicare Advantage and ACA Commercial Risk Adjustment models. The role ensures compliance with coding guidelines, documentation standards, quality metrics, and productivity requirements while supporting accurate risk adjustment...