E&B Analyst – US Healthcare Payer (FACETS)

Job Summary

We are looking for an experienced Enrollment & Billing (E&B) Analyst to support US Healthcare Payer operations. The role involves accurately processing member enrollment, eligibility, maintenance, and billing transactions using the TriZetto FACETS platform.

The ideal candidate should have strong knowledge of enrollment and billing operations, EDI 834 files, member maintenance, eligibility validation, billing reconciliation, and payment transactions. The individual will be responsible for resolving transaction fallout, maintaining accurate documentation, supporting employer groups, and meeting defined quality, productivity, SLA, and turnaround-time requirements.

Multiple location : Bangalore , Trivandrum, Hyderabad, Chennai

Key Responsibilities

1. Enrollment & Eligibility Processing

• Process new member additions, changes, removals, terminations, and demographic updates in TriZetto FACETS.
• Review enrollment and eligibility reports and identify transactions requiring additional action.
• Validate member enrollment documents for completeness and accuracy.
• Verify and remediate member addresses using approved sources.
• Identify and resolve enrollment fallout from employer portals, BenefitFocus Enrollment Center, and other self-service channels.
• Identify and correct EDI 834 file errors.
• Support implementation and maintenance of new and renewing 834 files.
• Save supporting documents in approved secure storage as per defined procedures.

2. National Accounts & Medicare Supplement

• Process assigned National Accounts files, including:

• Dual-year files

• Full files

• Eligibility spreadsheets

• Uploads

• Error mitigation

• Urgent enrollment transactions

• Process National Accounts enrollment reports according to assigned complexity.

• Validate Medicare Supplement spousal discount eligibility.

• Add or move subscribers to the appropriate subgroup.

• Maintain Medicare Supplement membership accurately.

3. Billing Processing & Reconciliation

• Review cash receipt transactions and reallocate applicable receipts across subgroups in TriZetto FACETS, without handling physical cash.
• Reconcile billed and paid amount variances at the member level.
• Research and resolve outstanding payment balances following group plan termination.
• Process assigned National Accounts billing and payment reconciliation reports.
• Investigate and resolve billing discrepancies accurately and within defined timelines.

4. Communication & Customer Support

• Handle inbound and outbound calls and email correspondence related to enrollment and billing inquiries.
• Communicate with employer groups and plan administrators to provide updates and resolve issues.
• Maintain accurate documentation of interactions, actions taken, outcomes, and follow-up requirements.
• Escalate critical, regulatory, audit, or unresolved issues through defined procedures.

5. Workflow, Quality & Reporting

• Manage assigned work inventory across different complexity levels.
• Meet defined productivity, quality, SLA, and turnaround-time targets.
• Perform self-quality checks before transaction closure.
• Maintain accurate case notes, trackers, reports, and status records.
• Support backlog reduction and inventory aging control.
• Assist with audit requests and continuous improvement initiatives.

Mandatory Skills & Competencies

• Knowledge of US Healthcare Payer Enrollment, Eligibility, Membership, and Billing operations.

• Hands-on experience with TriZetto FACETS Enrollment and Billing workflows.

• Strong understanding of:

• EDI 834 files

• Member maintenance

• Eligibility verification

• Subgroup structures

• Billing variances

• Payment reconciliation

• Strong attention to detail and numerical accuracy.

• Good documentation, communication, analytical, and problem-solving skills.

• Ability to manage high-volume work queues and assignments across different complexity levels.

Preferred Skills

• Experience in Healthcare Payer / BPO operations.
• Experience with BenefitFocus Enrollment Center or similar enrollment platforms.
• Experience supporting National Accounts.
• Exposure to Medicare Supplement enrollment and billing.
• Experience with enrollment and billing reconciliation processes.

Qualifications & Experience

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

• B.Tech / B.E. / MCA / BCA / M.Sc IT / B.Sc IT or equivalent.

• 3–6+ years of experience in US Healthcare Payer:

• Enrollment

• Eligibility

• Membership

• Billing

• Related healthcare operations

• Healthcare payer or BPO experience preferred.

• Hands-on TriZetto FACETS experience is mandator