Sr. Healthcare Associate (A&G) - #101389

UST is searching for Healthcare Associates who will be responsible for processing Appeals and Grievances cases by evaluating the organization's initial decisions against CMS guidelines and enrollee benefits. Responsibilities will also include preparing a detailed summary statement of the appeal or grievance case, including research to substantiate the appeal or grievance, and for the end-to-end processing of each case. Cases must be documented in the highest quality possible, ensuring the Appeals and Grievances are performed timely, accurately and in accordance with CMS Grievance and Appeals regulations.

• Follow Grievances and Appeals processes and systems to ensure data quality to support UST’s quality, production and financial goals
• Investigate and thoroughly document findings on all grievances and appeals
• Prepare Appeal case recommendations for initial review process
• Coordinate appropriate reviewer assignment for Appeals and Grievance cases
• Responsible to move Appeals and Grievances through each review level to ensure timely completion
• Drive operational excellence into all processes and departmental interactions based on CMS and UST requirements
• Bring to management’s attention any system or process issues determined during the investigation of the appeal or grievance
• Coordinate effectively with the Information technology department on upgrades/fixes/changes
• Participate in the departmental audit/oversight program that focuses on continuous quality improvement
• Participate in compliance committees to help continuously improve initial decision making
• This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required
• At times may be asked to help quality audits

Qualifications:

• Bachelor’s degree an advantage but not required
• Minimum of 1 year healthcare experience
• Experience in a grievance and appeals, Medicare/Medicaid, claims, authorizations an advantage
• Strong communication skills are required to understand, interpret, and communicate ideas
• Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.)
• Strong analytical, organizational, planning and problem-solving skills
• Ability to effectively interface with employees at different levels
• Ability to define problems, collect data, establish facts, and draw valid conclusions
• Ability to work in a fast-paced environment
• Ability to consistently meet deadlines

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.