Associate BPM Lead (Appeals & Grievances Analyst)

Role Description

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. We have a strong global presence and a dedicated workforce 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.

Acting in a quality assurance capacity, Appeals and Grievances Analysts are responsible for processing appeals and grievances by evaluating the organization's initial decisions against CMS guidelines and enrollee benefits, preparing a detailed summary statement of the appeal or grievance case, in...