We are looking for an experienced Enrollment & Billing (E&B;) Analyst with hands-on experience in TriZetto FACETS and US healthcare payer operations.

The candidate will be responsible for member enrollment, eligibility and demographic maintenance, billing transactions, reconciliation, fallout resolution, 834 file processing, and employer group support. The role requires strong attention to detail, numerical accuracy, documentation skills, and the ability to manage high-volume work queues while meeting quality and SLA requirements.

Key Responsibilities

- Review enrollment and billing reports generated from TriZetto FACETS and resolve transaction fallout.
- Process new member additions, changes, removals, terminations, and demographic updates.
- Validate member eligibility and enrollment documentation.
- Verify and update member addresses using approved USPS/Satori reporting.
- Identify and resolve enrollment issues received through employer portals and self-service channels.
- Identify and correct EDI 834 file errors and support new/renewing 834 file implementations.
- Process National Accounts enrollment files, eligibility spreadsheets, uploads, and urgent enrollment requests.
- Process enrollment reports based on assigned complexity.
- Validate Medicare Supplement spousal discount eligibility and maintain subscriber/subgroup information.
- Review cash receipt transactions and perform applicable receipt reallocations across subgroups in FACETS.
- Reconcile billed and paid amount variances at the member level.
- Research and resolve outstanding payment balances for terminated group plans.
- Handle enrollment and billing-related inbound/outbound calls and email correspondence.
- Communicate with employer groups and plan administrators to resolve enrollment and billing issues.
- Maintain accurate case notes,



trackers, reports, and supporting documentation.
- Perform self-quality checks and ensure transactions meet defined quality, productivity, SLA, and TAT requirements.
- Support backlog reduction, aging control, audit requests, and process improvement initiatives.

Mandatory Skills

- Hands-on experience with TriZetto FACETS enrollment and billing workflows.
- Experience in US Healthcare Payer Operations.
- Strong understanding of:
- Enrollment & Eligibility
- Membership Maintenance
- EDI / 834 Files
- Billing Transactions
- Billing Reconciliation
- Payment / Receipt Reallocation
- Subgroup Structures
- Enrollment Fallout Resolution
- Good numerical accuracy and attention to detail.
- Solid written and verbal communication skills.
- Ability to work with high-volume transactions and meet SLA/TAT requirements.

Experience & Qualifications

- 3–6+ years of experience in US healthcare payer enrollment, eligibility, membership, billing, or related operations.
- Hands-on FACETS experience is mandatory.
- Experience in healthcare payer/BPO operations is preferred.
- Bachelor's degree or equivalent qualification preferred.
- Preferred educational background: BTech / MCA / BCA / MSc IT / BSc IT.

Key Performance Areas

- Enrollment processing accuracy and first-pass quality.
- Billing reconciliation accuracy.
- SLA and turnaround-time adherence.
- Productivity and inventory management.
- Documentation completeness.
- Backlog and aging reduction.
- Resolution quality and rework reduction.

Work Locations: Chennai | Thiruvananthapuram | Bengaluru

Important: Candidates without hands-on TriZetto FACETS enrollment and billing experience may not be considered.

Apply now if you have relevant experience in US healthcare payer operations and hands-on FACETS exposure.

Work Location: In person

📌 E&B; Analyst – Enrollment & Billing (Thiruvananthapuram)
🏢 Closing Gap
📍 Thiruvananthapuram