Claims Operations Facets Lead

About the role

UST is searching for a Claims Operations Facets Lead who will 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. Role Location: Remote - US.

Responsibilities

• 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
• 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

Requirements

• 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
• Strong knowledge of SLA management, productivity management, operational governance, workforce management, and continuous improvement methodologies
• Excellent communication, stakeholder management, and leadership skills

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

Skills

FACETS, Claims Management, Healthcare Systems, Stakeholder Management

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.
• Eligible to participate in the Company’s 401(k) Retirement Plan with employer matching.
• Medical, dental, and vision insurance for employees and their dependents residing in the US.
• Company-paid Employee Only benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits.
• Option to purchase additional voluntary short-term disability benefits.
• Eligible to participate in a Health Savings Account (HSA) and a Flexible Spending Account (FSA)