Lead I - BPM- Claim

About the role

Claims Lead - BPM Role Summary We are seeking a Claims Lead to manage Facets-based claims operations within a Business Process Management (BPM) environment supporting a US healthcare payer.

What you'll do

• Operations Management Own overall claims delivery within the Facets adjudication environment, including workflow orchestration and execution oversight
• Manage daily production, work allocation, queue balancing, and operational throughput
• Drive consistency in claims processing across complexity segments, ensuring adherence to defined productivity benchmarks
• Maintain control over inventory health, aging, throughput, and operational performance across multiple work queues
• Monitor process KPIs, SLAs, and operational metrics to ensure business objectives are achieved

What you need

• Claims processing
• Audit
• Root cause analysis
• Compliance