A&G Lead II - #101391

JOB DESCRIPTION

At UST, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and help our health plans operate more efficiently.

Responsibilities:

• Develop and implement effective strategies that enables the department to maintain efficient and cost-effective processes
• Establish and maintain Grievance and Appeals processes and systems to ensure data quality to support UST HealthProof’s quality, production, and financial goals
• Drive operational excellence into all processes and departmental interactions based on CMS and UST HealthProof’s requirements
• Lead employees and other management in developing effective intercompany workflows for the Grievance and Appeals processes
• Operate a departmental audit/oversight program that focuses on continuous quality improvement
• Balance workload to optimize the effectiveness of the department
• Directly supervise exempt and non-exempt staff in accordance with company policies

Requirements:

• Bachelor’s degree in a related field. Relevant combination of education and experience may be considered in lieu of degree
• 3-5 years’ experience of progressive responsibility in an insurance or managed care environment
• At least 1 year supervisory or lead experience in insurance or managed care
• Experience in Grievance and Appeals or customer service in a managed care or insurance environment
• Knowledge of the Grievance and Appeals regulations per CMS

For more than 20 years, UST has worked side by side with the world’s best companies to make a real impact through transformation. Powered by technology, inspired by people and led by our purpose, we partner with our clients from design to operation. Through our nimble approach, we identify their core challenges, and craft disruptive solutions that bring their vision to life. With deep domain expertise and a future-proof philosophy, we embed innovation and agility into our clients’ organizations—delivering measurable value and lasting change across industries, and around the world. Together, with over 29,000 employees in 30 countries, we build for boundless impact—touching billions of lives in the process.