Manager, Claims Operations

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 4000 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.

At UST Health Proof, we envision a bold future for American healthcare. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serve as a compass guiding every action and decision.

Manager I (BPM), Claims Operations

UST Health Proof is looking for a Manager I, Claim Operations. The Claims Operations Manager I is responsible to develop and maintain metrics/reports/tools to support various claim initiatives and personnel. The Manager will provide execution and strategic expertise to support day to day inventory and claims initiatives success.

• Assess and manage claims inventory; track and manage inventory trends and proactively adjust resource levers as needed to maximize productivity to meet inventory management goals.
• Be solution‑oriented; analyze data, proactively assess business needs.
• Apply subject matter expertise to the business of claims processing and operations.
• Manage and coach individual contributor performance and quality using quantitative and qualitative data.
• Independently identify and resolve team issues with appropriate escalation.
• Train and coach staff and vendors on claims processes.
• Motivate and lead team members in accordance with Health Proof values and objectives.

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

• A minimum of 7 years of health insurance claims experience with progressive leadership responsibilities.
• An ability to independently direct the implementation of complex business projects.
• Working knowledge of other functions within insurance operations and shared services (benefits, enrollment, compliance, medical management, customer service, etc.).
• In-depth understanding of industry issues and opportunities and the ability to share gained knowledge.
• Effective communication: ability to obtain clear information and remove ambiguity as needed to arrive at shared expectations.
• Capability to approach problems as challenges and deal with them constructively; promoting this approach with all team members.
• Well‑developed organizational habits.
• Experience in MS Word, Excel, PowerPoint, and Visio.
• Operating knowledge of Lean Six Sigma and/or Agile, preferred.

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

$65,000–$80,000

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,…