Lead I - BPM-E&B Lead

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

E&B Lead – BPM (Business Process Management)

• The Enrollment & Billing (E&B) Lead is responsible for end-to-end operational leadership of member enrollment and billing services performed in TriZetto Facets.
• The role oversees enrollment maintenance, eligibility validation, 834 file fallout, reporting, payment reconciliation, communications support, quality governance, inventory management, service-level performance, and Business Process Management (BPM) initiatives for standard work and National Accounts to drive operational excellence, process optimization, and continuous improvement.

Essential Job Functions:
Operations Management

• Own daily enrollment and billing delivery across standard work and National Accounts.
• Manage work allocation, queue balancing, inventory aging, productivity, staffing coverage, and priority requests.
• Oversee enrollment additions, changes, terminations, demographic updates, eligibility validation, and billing reconciliation activities in TriZetto Facets.
• Ensure secure handling and retention of enrollment and billing documentation according to approved procedures.
• Drive BPM best practices to improve operational efficiency, process standardization, and workflow effectiveness.

Enrollment & Eligibility Oversight

• Provide functional oversight for new member enrollment, member maintenance, subgroup changes, Medicare Supplement enrollment, and spousal discount eligibility.
• Guide resolution of fallout from employer self-service tools, BenefitFocus Enrollment Center, enrollment reports, and 834 electronic files.
• Oversee new and renewing 834 file implementation and maintenance.
• Coordinate urgent, custom, dual-year, full-file, and spreadsheet-based National Accounts enrollment requests when assigned.

Billing & Reconciliation Oversight

• Oversee cash receipt review and reallocation to applicable subgroups in TriZetto Facets without handling cash.
• Guide member-level reconciliation of billed and paid amount variances.
• Oversee balances associated with terminated groups and custom National Accounts billing and payment reports.
• Provide escalation support for delinquency, cancellation, reinstatement, aging, and complex reconciliation work.

Quality, Compliance & Governance

• Drive first-time-right processing, quality calibration, root cause analysis, corrective action, and defect prevention.
• Ensure timely escalation and resolution planning for regulatory, audit, and compliance issues.
• Monitor service-level performance for enrollment, billing, communications, and compliance obligations.
• Ensure processing follows approved desktop procedures, controls, and change management requirements.

Stakeholder Management & Reporting

• Partner with Client operations leads, SMEs, employer groups, plan administrators, QA, training, compliance, and technology teams.
• Lead weekly operational reporting covering delivery, inventory, production, issues, risks, decisions, and support needs.
• Support monthly service performance reporting and governance reviews.
• Oversee timely inbound and outbound phone and email communications, critical issue escalation, and inquiry resolution.

People Leadership & Improvement

• Coach analysts and QA analysts across low-, mid-, and high-complexity work.
• Support training, cross-skilling, readiness validation, and performance improvement.
• Identify opportunities for standardization, workflow optimization, reporting improvements, automation, and BPM-driven process enhancements.
• Lead continuous improvement initiatives and process transformation activities.

Qualifications:
Mandatory Skills & Competencies

• Deep knowledge of US healthcare payer enrollment, eligibility, membership, and premium billing operations.
• Strong hands-on knowledge of TriZetto Facets enrollment and billing workflows.
• Understanding of 834 transactions, eligibility fallout, member maintenance, subgroup structures, cash receipt reallocations, and billing reconciliation.
• Strong leadership, inventory management, escalation, reporting, and stakeholder communication skills.
• Ability to manage tiered complexity, National Accounts work, and regulatory or audit-sensitive processes.
• Strong knowledge of Business Process Management (BPM), process improvement, workflow optimization, SOP governance, and operational excellence methodologies.

Qualifications

Education

• Bachelor's degree in Healthcare Administration, Business, Finance, Information Systems, or a related field.

Experience

• 8+ years in US healthcare payer enrollment, membership, eligibility, or billing operations.
• Minimum 2+ years in a team lead, SME, or supervisory capacity.
• Experience in high-volume, SLA-driven healthcare operations.
• Experience leading BPM, process improvement, or operational excellence initiatives is preferred.

Required Platform

• Hands-on experience with TriZetto Facets enrollment and billing functions.

Key Performance Indicators (KPIs)

• Enrollment processing accuracy
• Billing reconciliation accuracy
• Enrollment and billing turnaround-time adherence
• Communications response and resolution adherence
• Inventory aging and backlog reduction
• Productivity attainment
• Defect leakage and repeat-error reduction
• Timely compliance escalation and remediation
• Member and provider satisfaction results
• Process improvement outcomes, workflow efficiency gains, and BPM initiative success metrics.
• BTech/ MCA/ BCA/Msc IT/Bsc IT

Required Skills:

• Claims Management
• FACETS
• TriZetto
• Healthcare Systems

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.