Claims Examiner II

Team Lead, Claims – Lead I - BPM Who We Are

UST Health Proof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members' well‑being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all.

We have a strong global presence and a dedicated workforce of over 4,000 people spread across the world.

Our brand is built on the strong foundation of simplicity, integrity, people‑centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.

UST Health Proof is looking for a Claims Team Lead, reporting to the Claims Manager. The Claims Team Lead is responsible for a team of typically 12–15 claims examiners, adjusters, extensive interaction with client organization, and multiple stakeholders.

• Be responsible for directly managing a staff of typically 12–15 associates
• Be responsible for knowing and meeting client‑specified guidelines
• Be responsible for monitoring and management of the downline staff’s productivity targets and financial and procedural accuracy standards as established by management
• Collaborate on special projects as assigned by the manager; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by management
• Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality
• Assemble and assign projects that may include provider data, authorizations, enrolment, or other information

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

• 5+ years healthcare claims processing experience HRP
• Solid understanding and ability to effectively lead a claims team
• Good communication skills (verbal and written)
• Microsoft application experience, especially Excel is suggested
• ICD‑10 CPT and HCPCS coding is a plus
• Knowledge base of physician billing and hospital coding (ICD‑10, HCPC, CPT‑4), medical terminology, and authorization requirements
• Willingness to learn new skills
• Team collaborator
• Strong work ethic

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

Remote

$50,000–$55,000

Full‑time, regular employees accrue up to 16 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. They are eligible to participate in the Company's 401(k) Retirement Plan with employer matching. They and their dependents residing in the U.S. are eligible for medical, dental, and vision insurance, as well as the following Company‑paid 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. Certain regular employees may have the potential for quarterly incentive‑based bonuses and or commissions depending on role. 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…