Associate III - BPM- Claim Processor
ThiruvananthapuramFull-time3–5 yrsPosted 1 week ago
Mid-level banking role at UST in Thiruvananthapuram. Needs 3–5 years and a BCA, MCA or B.Tech.
About the role
Claims Processor – US Healthcare Payer (FACETS) | BPM Role Summary Claims Processors will support US Healthcare Payer and BPM operations, responsible for accurate and compliant end-to-end medical claims adjudication within the TriZetto FACETS platform. The role requires strong knowledge of benefits, pricing logic, provider validation, and payer rules while operating in a workflow-driven environment.
What you'll do
- End-to-End Claims Adjudication Process medical claims in TriZetto FACETS Claims module, including review, adjudication, pend/suspend handling, corrected claims
- Review member eligibility, benefits, claim type, provider details, and claim routing before final adjudication
- Ensure correct application of: Deductibles, copay, and coinsurance Covered vs. non-covered services Authorization and referral requirements Apply appropriate pricing…
- Workflow Alignment & BPM Operations Support claim handling aligned to claim submission and payment workflows, including claim status review, corrected claims
- Analyze and resolve eligibility-related pends, pricing and benefit validation pends, and provider or routing-related exceptions
What you need
- Claims processing
- Medical coding
- Internal audit
- Compliance