Associate III - BPM-E&B Analyst

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Summary:

UST is looking for….

E&B Analyst Role Summary The Enrollment & Billing (E&B) Analyst is responsible for accurately processing member enrollment, eligibility, maintenance, and billing transactions in TriZetto Facets. The role reviews source documents and system reports, resolves fallout, performs billing reconciliation and receipt reallocations, supports employer group communications, and meets defined quality, productivity, documentation, and turnaround-time requirements. Key Responsibilities Data Review & Maintenance • Review Enrollment and Billing reports generated from TriZetto Facets and identify fallout requiring additional work. • Verify member addresses and complete address remediation in TriZetto Facets using approved USPS or Satori reporting. • Validate member eligibility and enrollment documents for completeness and accuracy. • Save supporting documents to approved secure storage according to desktop procedures. Enrollment Processing • Process new member additions, changes to existing member information, removals, terminations, and demographic updates in TriZetto Facets. • Identify and correct fallout from employer portals, BenefitFocus Enrollment Center, and other self-service channels. • Identify and correct 834 electronic file errors. • Support implementation and maintenance of new and renewing 834 files. National Accounts & Medicare Supplement • Process assigned custom National Accounts files, including dual-year files, full files, eligibility spreadsheets, uploads, error mitigation, and urgent enrollment work. • Process National Accounts enrollment reports according to assigned complexity. • Validate Medicare Supplement spousal discount eligibility. • Add or move subscribers to the correct subgroup and maintain Medicare Supplement membership. Billing Processing & Reconciliation • Review cash receipt transactions and reallocate applicable receipts across subgroups in TriZetto Facets without handling cash. • Reconcile billed and paid amount variances at the member level. • Research and resolve outstanding payment balances after a group plan is terminated. • Process assigned custom National Accounts billing and payment reconciliation reports. Communication & Support • Handle inbound and outbound phone calls and email correspondence related to enrollment and billing inquiries. • Communicate with employer group customers and plan administrators to provide updates and resolve issues. • Document interactions, actions, outcomes, and required follow-up accurately. • Escalate critical, regulatory, audit, or unresolved issues according to approved procedures. Workflow, Quality & Reporting • Manage assigned inventory across applicable complexity tiers and meet productivity, quality, SLA, and turnaround-time requirements. • Perform self-quality checks before transaction closure. • Update case notes, trackers, reports, and status records accurately. • Support backlog reduction, aging control, audit requests, and continuous improvement activities. Mandatory Skills & Competencies • Knowledge of US healthcare payer enrollment, eligibility, membership, and billing operations. • Hands-on experience with TriZetto Facets enrollment and billing transactions. • Understanding of 834 files, member maintenance, eligibility verification, subgroup structures, billing variances, and payment reconciliation. • Strong attention to detail, numerical accuracy, documentation, communication, and problem-solving skills. • Ability to manage high-volume work queues and tiered-complexity assignments. Qualifications Education • Bachelor's degree in Healthcare Administration, Business, Finance, Information Systems, or a related field preferred. Experience • 3 to 6+ years in US healthcare payer enrollment, eligibility, membership, billing, or related operations. • Experience in healthcare payer or BPO operations preferred. Required Platform • Hands-on experience with TriZetto Facets enrollment and billing modules or workflows. Key Performance Indicators (KPIs) • Enrollment processing accuracy • Billing reconciliation accuracy • First-pass quality • Enrollment turnaround-time adherence • Billing reconciliation turnaround-time adherence • Communications response and resolution adherence • Productivity attainment • Inventory aging and backlog reduction • Documentation completeness and rework rate

What you need:

BTech/ MCA/ BCA/Msc IT/Bsc IT

Required Skills:

FACETS, EDI 834, Healthcare Systems, Enrollment

What you need:

What we believe:

We’re proud to embrace the same values that have shaped UST since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone, to champion diversity and inclusion and to place people at the centre of everything we do.

Humility:

We will listen, learn, be empathetic and help selflessly in our interactions with everyone.

Humanity:

Through business, we will better the lives of those less fortunate than ourselves.

Integrity:

We honour our commitments and act with responsibility in all our relationships.

Equal Employment Opportunity Statement

UST is an Equal Opportunity Employer. We believe that no one should be discriminated against because of their differences, such as age, disability, ethnicity, gender, gender identity and expression, religion, or sexual orientation.

All employment decisions shall be made without regard to age, race, creed, colour, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

UST reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

• To support and promote the values of UST.

• Comply with all Company policies and procedures