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Hiring UST BPO, 6/F One Campus Bldg. B, Fort Mckinley, Taguig City (2025)

09/07/2025

UST HealthProof is hiring for:

Associate BPM Team Lead and QA Role (US Registered Nurses) - WFH

To apply, please send your CV to:
📧 HiringUSTbpo@gmail.com ⬅️

Role description:

Perform prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, the intensity of service, and level of care, including appeal requests initiated by providers, facilities, and members
Review, research, and prepare documentation related to retrospective review requests and appeals in accordance with local, state, and federal regulatory and designated accreditation (e.g., NCQA) standards
Contact appropriate medical and support personnel to identify and recommend an alternative treatment, service levels, length of stays, etc. using approved clinical protocols
Follow out-of-area/out-of-network services and make recommendations on patient transfer to in-network services and/or alternative plans of care
May establish care plans and coordinate care through the health care continuum including member outreach assessments
Establish, coordinate, and communicate discharge planning needs with appropriate internal and external entities
Review patterns of care associated with disease progression; identify contractual services and organize delivery through appropriate channels
Research and resolve issues related to benefits, member eligibility, non-elective and non-authorized services, coordination of benefits, care coordination as needed
Develop and deliver targeted education for the provider community related to policies, procedures, benefits when appropriate
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required

Qualifications:

Registered Nurse with current, unrestricted US Registered Nurse license
3+ years of direct, clinical nursing experience (an advantage)
2+ years’ experience in US Healthcare in utilization management or case management
MCG Certification will be a plus
Healthedge HRCM or Guiding Care experience is a plus

Skills:

US Registered Nurse, Utilization Management

19/06/2025

BPO Hiring ‼️
Senior BPM Associate (Healthcare Voice)
20 openings
Taguig

Submit your CV to: HiringUSTBpo@gmail.com 📧

Job Description:
Customer Service Associates provide exceptional customer service to the UST customers via inbound Call Center Operations.

Duties/Responsibilities:
Receive and respond to inbound phone calls for customer assistance
Respond to outbound phone call requests
Document all calls in ticketing and tracking systems
Respond to customer inquiries and provide data to customers within a required time frame
Act as liaison between claims department and providers
Research customer claims in the primary payor systems
Ensure highest level of customer service on every call
Perform other duties as assigned or necessary

Required Skills/Abilities:
High school degree required; college level an advantage
Has at least 2 years of experience in healthcare operations or call center environment
Desired skill – Knowledge of Medicare/ Medicare Advantage plans
Able to maintain a full comprehensive understanding of the covered plan benefits
Excellent verbal and written communication skills.
Attention to detail and problem-solving skills
Basic understanding of MS Office applications, especially Word and Excel

Skills:
Healthcare,Call Center,Communication

18/06/2025

We are hiring‼️
BPM Associate (Healthcare Voice)

Submit your CV to: hiringUSTbpo@gmail.com 📧

Job Description:

The Customer Service Associates provide exceptional customer service to UST customers via inbound Call Center Operations.

Receive and respond to inbound phone calls for customer assistance
Respond to outbound phone call requests
Document all calls in ticketing and tracking systems
Respond to customer inquiries and provide data to customers within a required time frame
Act as liaison between claims department and providers
Research customer claims in the primary payor systems
Ensure highest level of customer service on every call
Perform other duties as assigned or necessary
Maintain a full comprehensive understanding of the covered benefits, coding and reimbursement policies and contracts

Required Skills/Abilities:

High school degree required; college level an advantage
At least 1 year of contact center experience with 6 months of healthcare experience
Knowledge of physician practice and hospital coding, billing and medical terminology, CPT, HCPCS, ICD-9 and ICD-10 an advantage
Excellent verbal and written communication skills.
Good Attention to detail and problem solving skills
Proficiency with MS Office applications, especially Word and Excel
Amenable to training onsite and hybrid work setup (McKinley)

Skills:

Healthcare,Call Center,Communication

27/02/2025

HIRING ‼️‼️‼️

Senior BPM Associate (Pioneer Account, Healthcare Helpdesk)

70 openings
Taguig
Job Description

The associate plays a critical role in delivering exceptional customer service by addressing inquiries and resolving issues related to insurance benefits, provider contracts, eligibility, and claims. This position requires strong communication, problem-solving, and analytical skills to ensure customer satisfaction and operational efficiency.

Responsibilities:

Respond to customer inquiries via telephone and written correspondence, providing accurate and comprehensive information about insurance benefits, claims, and provider contracts
Analyze customer issues and deliver effective solutions promptly and professionally
Retrieve and document customer information, activities, and changes accurately within the database
Maintain detailed documentation of inquiry outcomes to ensure proper tracking and analysis
Build and sustain positive relationships with customers while collaborating with internal teams to handle requests efficiently and in a timely manner
Research and analyze data to address operational challenges and resolve customer service issues
Manage follow-up communications via calls or emails to ensure customer satisfaction and issue resolution
Adapt to non-standard practices and procedures using automated systems while maintaining high levels of accuracy and compliance
Understand and respond effectively to the needs and expectations of both internal and external customers.

Key Qualifications:

Education: High school diploma or equivalent is required
Experience: Minimum of 1 year of experience in an automated customer service environment, or an equivalent combination of education and experience
Skills:
Strong oral, written, and interpersonal communication abilities
Excellent problem-solving and analytical skills
Proficiency in using computer systems and databases for data entry and retrieval
Ability to manage multiple tasks and prioritize effectively in a fast-paced environment
Customer-focused mindset with a commitment to delivering exceptional service
Strong facilitation skills and the ability to coordinate with multiple teams
Preferred Attributes

Proven ability to handle moderately complex functions with minimal supervision
Demonstrated capability to adapt and respond to diverse customer needs and scenarios
Amenable to work nightshift and onsite (Taguig)

Skills

Healthcare, Customer Service, Call Center, Communication

Send your CV to: HiringUSTBPO@gmail.com

27/02/2025

HIRING ‼️‼️‼️

Senior BPM Associate (Medical Claims, March 2025)

31 openings
Taguig

Job Description

RESPONSIBILITIES

Process new claims or modify existing claims according to the appropriate and applicable action
Analyze claims to determine appropriate action to approve or deny a claim for payment
Determine accurate payment criteria for clearing pending claims based on defined policies and procedures
Research claims edits to determine appropriate benefit application utilizing established criteria, applies physician contract pricing as needed for entry-level claims
Review and address provider inquiries regarding claim adjudication
Ability to understand and apply knowledge of medical coding (if applicable) and various medical claims forms to the claims process
Demonstrate ability to work on high volume of repetitive claims
Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards

QUALIFICATIONS

2 to 5 years of medical claims processing experience
Experience in Blue Card or Blue Squared is required
Experience with medical coding to include diagnosis coding and terminology is an advantage
Knowledge in US Healthcare Practice, Medical Coding (ICD-10, CPT4, DRG, HCPCS), Clinical Documentation Improvement, medical terminologies, EDI. HIPAA protocol understanding is a must
Ability to multi-task and follow documented claims processes with minimal supervision
Excellent verbal and written business communication skills required
Strong attention to detail and the ability to make appropriate decisions based on information presented
Amenable to start on March 3, 2025

20/08/2024

UST Global, Inc. (UST HealthProof) is hiring for:

Associate BPM Team Lead and QA Role (US Registered Nurses)

To apply, please send your CV to:
📧 HiringUSTbpo@gmail.com ⬅️

Role description:

Perform prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, the intensity of service, and level of care, including appeal requests initiated by providers, facilities, and members
Review, research, and prepare documentation related to retrospective review requests and appeals in accordance with local, state, and federal regulatory and designated accreditation (e.g., NCQA) standards
Contact appropriate medical and support personnel to identify and recommend an alternative treatment, service levels, length of stays, etc. using approved clinical protocols
Follow out-of-area/out-of-network services and make recommendations on patient transfer to in-network services and/or alternative plans of care
May establish care plans and coordinate care through the health care continuum including member outreach assessments
Establish, coordinate, and communicate discharge planning needs with appropriate internal and external entities
Review patterns of care associated with disease progression; identify contractual services and organize delivery through appropriate channels
Research and resolve issues related to benefits, member eligibility, non-elective and non-authorized services, coordination of benefits, care coordination as needed
Develop and deliver targeted education for the provider community related to policies, procedures, benefits when appropriate
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required

Qualifications:

Registered Nurse with current, unrestricted US Registered Nurse license
3+ years of direct, clinical nursing experience (an advantage)
2+ years’ experience in US Healthcare in utilization management or case management
MCG Certification will be a plus
Healthedge HRCM or Guiding Care experience is a plus

Skills:

US Registered Nurse, Utilization Management

19/08/2024

Hiring CSR:
Position: Senior BPM Associate (Healthcare Voice, Aug 26 start date, 2nd batch: Sept. 23, 2024)

25 Openings, Taguig

To apply, please send your CV to: ⤵️
HiringUSTbpo@gmail.com ⬅️

Role description:

The Customer Service Associates provide exceptional customer service via inbound Call Center Operations.

Duties/Responsibilities:

Receive and respond to inbound phone calls for customer assistance
Respond to outbound phone call requests
Document all calls in ticketing and tracking systems
Respond to customer inquiries and provide data to customers within a required time frame • Act as liaison between claims department and providers
Research customer claims in the primary payor systems
Ensure highest level of customer service on every call
Perform other duties as assigned or necessary
Required Skills/Abilities:

High school degree required
3 months of call center experience
Knowledge of Medicare/ Medicare Advantage plans an advantage
Maintain a full comprehensive understanding of the covered plan benefits
Excellent verbal and written communication skills
Attention to detail and problem-solving skills
Basic understanding of MS Office applications, especially Word and Excel
Amenable to work onsite (Taguig), nightshift and fixed term employment. Flexibility to work on some weekends required depending on business need

Skills

Healthcare,Call Center,Call Center Operations

09/08/2024

Hiring CSR:
Position: Senior BPM Associate (Healthcare Voice, Aug 26 start date)

25 Openings, Taguig

To apply, please send your CV to: ⤵️
HiringUSTbpo@gmail.com ⬅️

Role description:

The Customer Service Associates provide exceptional customer service via inbound Call Center Operations.

Duties/Responsibilities:

Receive and respond to inbound phone calls for customer assistance
Respond to outbound phone call requests
Document all calls in ticketing and tracking systems
Respond to customer inquiries and provide data to customers within a required time frame • Act as liaison between claims department and providers
Research customer claims in the primary payor systems
Ensure highest level of customer service on every call
Perform other duties as assigned or necessary
Required Skills/Abilities:

High school degree required
3 months of call center experience
Knowledge of Medicare/ Medicare Advantage plans an advantage
Maintain a full comprehensive understanding of the covered plan benefits
Excellent verbal and written communication skills
Attention to detail and problem-solving skills
Basic understanding of MS Office applications, especially Word and Excel
Amenable to work onsite (Taguig), nightshift and fixed term employment. Flexibility to work on some weekends required depending on business need

Skills

Healthcare,Call Center,Call Center Operations

18/06/2024

UST Global, Inc. (UST HealthProof) is hiring for:

Associate BPM Lead (UM US Registered Nurses)

To apply, please send your CV to:
📧 HiringUSTbpo@gmail.com ⬅️

Role description:

Perform prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, the intensity of service, and level of care, including appeal requests initiated by providers, facilities, and members
Review, research, and prepare documentation related to retrospective review requests and appeals in accordance with local, state, and federal regulatory and designated accreditation (e.g., NCQA) standards
Contact appropriate medical and support personnel to identify and recommend an alternative treatment, service levels, length of stays, etc. using approved clinical protocols
Follow out-of-area/out-of-network services and make recommendations on patient transfer to in-network services and/or alternative plans of care
May establish care plans and coordinate care through the health care continuum including member outreach assessments
Establish, coordinate, and communicate discharge planning needs with appropriate internal and external entities
Review patterns of care associated with disease progression; identify contractual services and organize delivery through appropriate channels
Research and resolve issues related to benefits, member eligibility, non-elective and non-authorized services, coordination of benefits, care coordination as needed
Develop and deliver targeted education for the provider community related to policies, procedures, benefits when appropriate
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required

Qualifications:

Registered Nurse with current, unrestricted US Registered Nurse license
3+ years of direct, clinical nursing experience (an advantage)
2+ years’ experience in US Healthcare in utilization management or case management
MCG Certification will be a plus
Healthedge HRCM or Guiding Care experience is a plus

Skills:

US Registered Nurse, Utilization Management

29/05/2024

UST Global, Inc. is hiring for:

CSR: Senior BPM Associate (A&G Analyst)
📍Mckinley, Taguig - Hybrid work set-up

To apply, please send your CV to:
HiringUSTbpo@gmail.com

Role description

Job Summary:

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, by 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. All appeals and grievance 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.

Responsibilities:

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

Requirements:

Bachelor’s degree or relevant combination of education and experience may be considered in lieu of degree
Certification or progress toward certification is highly preferred and encouraged
Experience in a grievance and appeals environment, including experience with the grievance and appeals regulations per CMS
Experience in medical benefits and health care industry regulations and processes; experience in claims, authorizations, and Medicare Advantage plans
Experience working in or with Medicare Advantage plans, or Independent Review Entities
Experience with CMS regulations regarding Medicare Advantage, and Medicare Advantage plans appeals and grievance processes
Knowledge in claims, authorizations, and Medicare Advantage plans
Proven problem-solving skills and ability to translate knowledge to corporate departments
Strong communication skills are required to understand, interpret, and communicate ideas
Strong analytical, organizational, planning, and problem-solving skills
Ability to effectively interface with employees at all levels
Ability to define problems, collect data, establish facts, and draw valid conclusions
Demonstrated track record of generating results and having an impact on organizations
Strong focus and drive to serve the customer
Ability to work in a high paced environment
Ability to consistently meet deadlines

Skills

Healthcare,Appeals,Grievances

29/05/2024

UST Global, Inc. is hiring for:

SAP SD BA Consultant

1 opening: 📍Mckinley, Taguig

To apply, please send your CV to:
HiringUSTbpo@gmail.com

Job Description: SAP – Sales & Distribution (SD/ S/4 HANA)

Roles/Responsibilities:

● Responsible for planning and executing SAP Implementation / Development / Support activities regard to SAP Sales and Distribution (SD).

● Understand client requirements, provide solutions, functional specifications and configure the system accordingly.

● Ability to create presentation/workshop decks for Blueprint that need to be conveyed and be able to present them to the client.

● Ability to create Process Flows in Microsoft Visio’s for the client’s proposed business processes.

● Ability to create Process Definition Document / Design Document (PDD) and Business Process Procedure (BPP) for the solutions provided.

● Ability to configure SAP SD (Sales and Distribution) and deliver work products / packages confirming to the Client's Standards & Requirements.

● Strong configuration hands on experience in Sales and Distribution

● Integration of the SD module with other SAP modules and with external applications.

● In addition to the above the candidate should have been involved in the following during the life cycle of SAP implementation: o Unit Testing, Cycle Testing o Integration Testing o User Manual Preparation o User Support activities o Exposure to ASAP and other structured implementation methodologies o Regularly interact with the onsite team/client o Provide status updates in daily/weekly conference calls o Maintain cordial relationship with onsite team/client Skills/Experience

Requirements:

MUST HAVE:

● 2 to 6 years of working on the SD module in SAP implementation projects

● Implementation experience should be in version ECC 6 and should have experience with S/4 HANA

● Hands on experience in configuring / defining the following in the SD module: o SAP SD – Sales including Quotation and Sales Orders o SAP SD – Shipping o SAP SD – Pricing o SAP SD – Billing o SAP SD - Transportation o SAP SD - Invoice verification

● Should have good written and oral communication skills

● Must be a good team player Familiarity on the basic business processes with the following Functional Areas:

● SAP FI/CO

● SAP MM

● SAP PS

● SAP HR

NICE TO HAVE

● Exposure in GTS or DSD module

● SAP Certification on SD Module

● Used Solution Manager in the implementation

● Experience in SAP Country India Version (CIN) configuration and applications

● Worked on integration with other modules like FI/CO, MM, SD, HR

● Training / Awareness on Net Weaver Components

● Team Leading Experience would be added advantage

● Exposure to interfaces like ALE/IDOC or EDI/IDOC with little technical knowledge

Skills:

Sap Sd,Sap S4 Hana,Sap Ecc

29/05/2024

UST Global, Inc. is hiring for:

Associate BPM Lead (UM US Registered Nurses)

To apply, please send your CV to:
📧 HiringUSTbpo@gmail.com ⬅️

Role description:

Perform prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, the intensity of service, and level of care, including appeal requests initiated by providers, facilities, and members
Review, research, and prepare documentation related to retrospective review requests and appeals in accordance with local, state, and federal regulatory and designated accreditation (e.g., NCQA) standards
Contact appropriate medical and support personnel to identify and recommend an alternative treatment, service levels, length of stays, etc. using approved clinical protocols
Follow out-of-area/out-of-network services and make recommendations on patient transfer to in-network services and/or alternative plans of care
May establish care plans and coordinate care through the health care continuum including member outreach assessments
Establish, coordinate, and communicate discharge planning needs with appropriate internal and external entities
Review patterns of care associated with disease progression; identify contractual services and organize delivery through appropriate channels
Research and resolve issues related to benefits, member eligibility, non-elective and non-authorized services, coordination of benefits, care coordination as needed
Develop and deliver targeted education for the provider community related to policies, procedures, benefits when appropriate
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required

Qualifications:

Registered Nurse with current, unrestricted US Registered Nurse license
3+ years of direct, clinical nursing experience (an advantage)
2+ years’ experience in US Healthcare in utilization management or case management
MCG Certification will be a plus
Healthedge HRCM or Guiding Care experience is a plus

Skills:

US Registered Nurse, Utilization Management

Hiring UST BPO

09/07/2025

19/06/2025

18/06/2025

27/02/2025

27/02/2025

20/08/2024

19/08/2024

09/08/2024

18/06/2024

29/05/2024

29/05/2024

29/05/2024

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