Job Description

Who We Are UST HealthProof 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. Role Description UST HealthProof is looking for a Senior Claims Examiner, reporting to the Claims Team Leader. The Senior Claims Examiner is responsible for the adjudication of healthcare claims utilizing specific policies and procedures. The Opportunity Be responsible for processing assigned claims based on client‑specified guidelines or as directed by the team leader. Be responsible for meeting productivity targets, financial and procedural accuracy standards as established by management. Mentor junior members of the team. Collaborate with other team members on special projects as assigned by the team leads; 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 the team leader. 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. Participate in projects assigned by the team leader; these projects may include provider data, authorizations, enrollment, or other activities. What You Need High School degree required. 3–5 years healthcare claims processing experience. Solid understanding and ability to analyse claim data. 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. The ability to adapt quickly to a fast‑paced environment. A self‑starter and quick learner. Team player with an ability to collaborate. Compensation and Benefits Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST HealthProof provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below. Role Location: Remote Compensation Range: $22 – $25 per hour 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 the year) and are eligible to participate in the Company’s 401(k) program with employer matching. They and their dependents residing in the U.S. are eligible for medical, dental, and vision insurance. Part‑time temporary employees receive 6 days of paid sick leave each year (pro‑rated for new hires throughout the year). All U.S. employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws. Our Values At UST HealthProof, 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. Simplicity: Simplifying complexity underlines everything we do—this approach is what makes us unique. Integrity: Integrity is our currency to build relationships. We believe in being open and honest. It demonstrates that we are here to do the right thing, no matter who is watching. People‑centricity: Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. Leadership: Taking ownership is about taking initiative, being in‑charge and driving things to completion. Mission: A future possible only when health plans are free from administrative burdens so they can truly focus on what matters more – their members’ well‑being. Equal Employment Opportunity Statement UST HealthProof is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and “fair chance” ordinances. UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance. Skills claims management, medical terminology, claim data analysis, healthcare claims processing, HCPCS coding. #J-18808-Ljbffr

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