{"id":2771981,"url":"https://alion.io/job/ust-claims-lead-supervisor","title":"Claims Lead / Supervisor","company":{"id":1774626,"name":"UST","domain":"ust.com","url":"https://alion.io/company/ust-com","size_band":"5000+","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"RippleHire","truth_index":null},"role":"Industrial Engineering","role_family":"Industrial Engineering","seniority":"lead","employment_type":null,"work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Taguig, Philippines"],"countries":["PH"],"hiring_countries":[],"hiring_countries_total":0,"salary":null,"salary_estimate":{"min_usd":19500,"max_usd":50000,"period":"year","method":"global_role_cell_scaled_by_country","sample_n":2219},"experience_years_min":8,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"SLI/SLO/SLA","optional":false}],"status":"live","first_seen_at":"2026-10-05T00:00:00Z","employer_posted_date":"2026-10-17","last_verified_at":"2026-10-18T05:36:16Z","board_verified":true,"closed_at":null,"days_open":13,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":13},"description":"Claims Lead - BPM (Facets Claims Operations)\nRole 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, and SLA compliance. The ideal candidate will have strong expertise in Facets claims adjudication, healthcare claims operations, and operational leadership. Key ResponsibilitiesOperations ManagementLead end-to-end claims delivery within the Facets adjudication environment.Manage daily production, work allocation, workload balancing, and throughput.Monitor inventory, aging, productivity, and operational performance across multiple queues.Ensure adherence to KPIs, SLAs, and productivity targets.Drive consistency and efficiency in claims processing activities.Escalation & Functional OversightServe as the functional lead for claims adjudication and workflow management.Pricing discrepanciesBenefit interpretation issuesRetro eligibility scenariosAdjusted claims processingEnsure alignment with Facets configurations, edits, and system-driven outcomes.Partner with stakeholders to identify gaps and implement corrective actions.Governance & QualityEnsure compliance with coding standards, payment policies, payer edits, and governance requirements.Lead audit reviews, calibration sessions, root cause analysis, and defect prevention initiatives.Monitor accuracy across payment outcomes, compliance measures, and operational metrics.Address systemic issues related to pricing, eligibility, configuration, and provider data.\nDrive continuous improvement initiatives to enhance first-pass accuracy and reduce rework.\nMandatory Skills & Competencies\nStrong expertise in Facets claims adjudication and workflow management.\nDeep understanding of:Claims lifecycle (intake, adjudication, adjustments)\nBenefits administration\nPricing methodologies\nPayment policies\nSystem edits and pend management\nClaims resolution workflows\n\nStrong knowledge of BPM operations, governance, process improvement, and quality management.\nExperience managing complex, exception-based claims environments.\nProven ability to manage SLA-driven operations, stakeholder relationships, and offshore delivery models.\nStrong leadership, analytical, problem-solving, and communication skills.\nQualifications\nGraduate degree required8+ years of experience in U.S. Healthcare Claims OperationsMinimum 2+ years of experience in a Team Lead or Operations Lead roleStrong Facets expertise is requiredBlue Plan/BlueCard experience an advantageExperience in managing day-to-day operations, operational excellence initiatives, and process improvement programs","description_format":"text","description_chars":2772,"description_truncated":false,"requirements":{"experience_years_min":8,"management_years_min":2,"team_size_min":null,"manages_managers":false,"education":null,"security_clearance":false,"languages":[]},"benefits":[],"hiring_locations":[],"hiring_excludes":[],"relocation_offered":false,"industries":["IT Consulting & Digital Transformation","IT Outsourcing & Dedicated Teams"],"lifecycle":[{"event":"open","at":"2026-10-17T06:35:48Z"}],"visa":[],"liveness":{"score":53,"band":"ok","label":"Likely open","p_open":1,"p_active":0.708,"p_room":0.75,"age_days":13,"expected_fill_days":14,"reasons":["conf:2","win:late","comp:brand"],"computed_at":"2026-10-18T08:15:56Z"},"pay":null,"html_url":"https://alion.io/job/ust-claims-lead-supervisor","json_url":"https://alion.io/job/ust-claims-lead-supervisor.json","meta":{"generated_at":"2026-10-18T08:15:56Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":12397,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-19T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":1774626},"rest":"https://alion.io/mcp/rest/get_company?id=1774626"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fust-claims-lead-supervisor"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fust-claims-lead-supervisor"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fust-claims-lead-supervisor"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/ust-claims-lead-supervisor\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fust-claims-lead-supervisor"}]}