Associate III - BPM-E&B Analyst

About The Job:
Client is looking for....

E&B Analyst

• 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.

Essential Job Functions:
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 US Government Client 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.

Qualifications:
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.

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
• BTech/ MCA/ BCA/Msc IT/Bsc IT

Required Skills:

• FACETS
• EDI 834
• Healthcare Systems
• Enrollment

How to Apply: Interested candidates are encouraged to respond/submit their updated resumes, and for additional job opportunities, please visitJobs In India – VARITE.

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Experience Level Bonus Referral:

• 0-2 years - INR 5,000
• 2-6 years - INR 7,500
• 6+ years - INR 10,000

About VARITE: VARITE is a global staffing and IT consulting company providing technical consulting and team augmentation services to Fortune 500 Companies in USA, UK, CANADA and INDIA. VARITE is currently a primary and direct vendor to the leading corporations in the verticals of Networking, Cloud Infrastructure, Hardware and Software, Digital Marketing and Media Solutions, Clinical Diagnostics, Utilities, Gaming and Entertainment, and Financial Services.

Equal Opportunity Employer:

VARITE is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, marital status, veteran status, or disability status.