E&B Lead – BPM (Business Process Management)(Lead I - BPM-E&B Lead)

E&B Lead – BPM (Business Process Management)

Job Summary

We are looking for an experienced E&B Lead to provide end-to-end operational leadership for US Healthcare Payer Enrollment & Billing services using TriZetto Facets. The role will oversee enrollment, eligibility, 834 file processing, billing reconciliation, quality, inventory, SLA performance, stakeholder management, and BPM-driven process improvement.

Multiple location : Bangalore , Trivandrum, Hyderabad, Chennai

Key Responsibilities

Operations Management

• Lead daily Enrollment & Billing operations across standard work and National Accounts.
• Manage work allocation, queue balancing, inventory aging, productivity, staffing, and priority requests.
• Oversee enrollment, eligibility, member maintenance, and billing activities in TriZetto Facets.
• Drive BPM best practices, process standardization, and workflow optimization.

Enrollment & Eligibility

• Oversee member enrollment, terminations, demographic updates, subgroup changes, and eligibility validation.
• Resolve fallout from BenefitFocus, employer portals, enrollment reports, and EDI 834 files.
• Oversee new and renewing 834 file implementation and maintenance.
• Support urgent and complex National Accounts enrollment requirements.

Billing & Reconciliation

• Oversee cash receipt review and reallocation within Facets.
• Guide member-level billed vs. paid reconciliation.
• Manage terminated-group balances and National Accounts billing reports.
• Provide escalation support for delinquency, cancellation, reinstatement, aging, and complex reconciliation issues.

Quality, Compliance & Governance

• Drive first-time-right processing, quality calibration, RCA, corrective actions, and defect prevention.
• Monitor SLA and compliance performance.
• Ensure adherence to SOPs, controls, audit requirements, and change management processes.

Stakeholder & Reporting

• Partner with operations leads, SMEs, employer groups, QA, training, compliance, and technology teams.
• Lead weekly operational reporting covering production, inventory, risks, issues, and support requirements.
• Support monthly service reviews and governance meetings.
• Oversee customer communications and critical issue escalations.

People Leadership & Process Improvement

• Coach analysts and QA teams across different complexity levels.
• Support training, cross-skilling, readiness, and performance improvement.
• Identify opportunities for standardization, automation, workflow optimization, and reporting improvements.
• Lead continuous improvement and BPM transformation initiatives.

Mandatory Skills

• US Healthcare Payer Enrollment, Eligibility, Membership & Billing
• TriZetto Facets – Enrollment & Billing
• EDI 834
• Member Maintenance & Subgroup Management
• Billing Reconciliation & Cash Receipt Reallocation
• National Accounts
• BPM & Process Improvement
• SLA, Quality & Inventory Management
• Escalation & Stakeholder Management
• SOP & Operational Governance

Preferred Skills

Healthcare Payer Operations | National Accounts | BenefitFocus | EDI 834 | BPM/Process Improvement | Quality & Governance | Automation | Operational Excellence

Qualifications & Experience

• B.Tech / B.E. / MCA / BCA / M.Sc IT / B.Sc IT or equivalent.
• Bachelor's degree preferred in Healthcare Administration, Business, Finance, Information Systems, or related field.
• 8+ years of experience in US Healthcare Payer Enrollment, Membership, Eligibility, or Billing Operations.
• 2+ years in a Team Lead, SME, or Supervisory role.
• Experience in high-volume, SLA-driven healthcare operations.
• Experience leading BPM, process improvement, or operational excellence initiatives preferred.
• Hands-on TriZetto Facets experience is mandatory.

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