Role description

At UST, we help the world’s best organizations grow and succeed through transformation. Bringing together the right talent, tools, and ideas, we work with our client to co-create lasting change. Together, with over 30,000 employees in 30+ countries, we build for boundless impact—touching billions of lives in the process. Visit us at .

Summary:

UST is looking for….

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 workplace. The individual will manage pended, exception, and reprocessed claims with adherence to productivity, quality, SLA, and compliance requirements. Key Responsibilities End-to-End Claims Adjudication Process medical claims in TriZetto FACETS Claims module, including review, adjudication,



pend/suspend handling, corrected claims, and reprocessing as required. Review member eligibility, perks, 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 methodologies within FACETS, including: Fee schedule-based pricing Institutional reimbursement logic Contractual payment rules Identify and resolve discrepancies related to pricing configuration, perk-plan interaction, and claim setup issues. Workflow Alignment & BPM Operations Support claim handling aligned to claim submission and payment workflows, including claim status review, corrected claims, EOP understanding, COB/TPL handling, and suspension/rejection analysis. Analyze and resolve eligibility-related pends, pricing and benefit validation pends, and provider

📌 Associate Iii Thiruvananthapuram
🏢 UST
📍 Thiruvananthapuram