Claims Operations

Claims Operations

The Role

UST is searching for Claims Operations who will act as the primary client-facing lead and trusted advisor for Claims Operations, managing executive stakeholder relationships, governance forums, risk reviews, and operational decision-making.

What You’ll Do

·Lead the end-to-end transition and operational delivery of FACETS Claims Operations, ensuring successful knowledge acquisition, operational readiness, stabilization, and seamless transition to steady-state support

·Partner with client SMEs and business leaders to assess current-state operations, define future-state operating models, and establish service delivery frameworks

·Drive transition planning, knowledge transfer execution, readiness assessments, and operational acceptance activities to ensure a successful handoff to delivery teams

·Oversee FACETS claims adjudication operations, ensuring adherence to productivity, quality, accuracy, turnaround time, and SLA commitments

·Establish governance processes, performance metrics, reporting dashboards, and controls to monitor operational performance and deliver continuous visibility to stakeholders

·Identify operational risks, process gaps, dependencies, and improvement opportunities, implementing mitigation plans and corrective actions to ensure delivery stability

·Collaborate with cross-functional teams including Enrollment, Provider Operations, Configuration, Application Support, and Technology teams to drive end-to-end process effectiveness

·Lead continuous improvement, automation, and transformation initiatives to enhance operational efficiency, quality, customer experience, and business outcomes

·Provide leadership, coaching, and direction to onshore and offshore operations teams, fostering a culture of accountability, collaboration, and operational excellence

·Support workforce planning, capacity management, forecasting, and resource optimization to align with client demand and business objectives

·Ensure compliance with healthcare payer regulations, client policies, audit requirements, and operational governance standards

·Lead Healthcare BPM delivery and operations management, ensuring SLA adherence, productivity targets, quality performance, operational governance, and continuous process improvement

·Drive BPM transformation initiatives, process standardization, automation opportunities, operational excellence programs, and service delivery optimization across healthcare payer operations

·Manage Healthcare BPM/BPO delivery teams, stakeholder governance, performance management, and operational reviews to achieve business outcomes and customer satisfaction goals

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What You Need

·10+ years of Healthcare Payer Operations and BPM/BPO Operations experience with deep expertise in FACETS Claims Processing and Adjudication

·Proven experience leading large-scale transition, transformation, and managed services engagements

·Strong understanding of Commercial, Medicare, Medicaid, and Government Programs claims operations

·Demonstrated success managing client relationships, operational governance, service delivery, and cross-functional teams

·Experience managing large-scale onsite/offshore BPM delivery teams

·Skills

·Strong knowledge of SLA management, productivity management, operational governance, workforce management, and continuous improvement methodologies

·Excellent communication, stakeholder management, and leadership skills

·Preferred Qualifications

·Experience leading Healthcare BPM transformation programs

·Exposure to Lean Six Sigma, Process Excellence, Automation, and AI-enabled operational transformation initiatives

·Knowledge of FACETS and Healthcare Payer operational workflows across Claims, Enrollment, Provider, Billing, and Configuration functions

·Success Measures

·SLA/KPI Compliance

·Client Satisfaction (CSAT)

·Quality & Productivity Improvement

·Successful Transition Execution

·Cost & Margin Optimization

·Automation & Transformation Benefits

·Employee Engagement & Retention

·BPM Delivery Excellence

·Operational Efficiency & Continuous Improvement

·Governance, Compliance & Service Delivery Performance

Location & Compensation

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

Role Location: Seattle, Washington

Compensation Range:$63,000-$95,000

Who We Are

Since 1999, UST has worked side by side with the world’s best companies to make a powerful impact through transformation. Headquartered in the United States, UST is powered by technology, driven by AI, inspired by people, and led by our purpose, we partner with our clients from design to operation. Our AI-driven digital solutions, proprietary platforms, engineering, R&D, products, and innovation ecosystem turn core challenges into impactful, disruptive business outcomes. With deep industry knowledge and a future-ready mindset, we infuse expertise, innovation, and agility into our clients’ organizations—delivering measurable value and positive lasting change for them, their customers, and communities around the world. Together, with 30,000+ employees in 30+ countries, we build for boundless impact—touching billions of lives in the process. Visit us at.

Benefits

Full-time, regular employees accrue a minimum of 10 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave and jury duty. They are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance, as well as the following Company-paid Employee Only benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses as allowable under IRS guidelines. Benefits offerings vary in Puerto Rico.

Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching.

Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance.

Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year).

All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws.

Equal Employment Opportunity Statement

UST is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and “fair chance” ordinances.

UST reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

#UST

#CB

#LI-FW