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….

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 solid knowledge of benefits, pricing logic,



provider validation, and payer rules while operating in a workflow-driven environment. 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, advantages, 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, advantage-p

📌 Associate Iii Thiruvananthapuram
🏢 UST
📍 Thiruvananthapuram