Claims Processor US Healthcare Payer (FACETS)

Experience: 3+ Years
Location: Chennai / Thiruvananthapuram (TVM) / Bangalore

NIGHT SHIFT

We are looking for experienced US Healthcare Payer Claims Processors with robust hands-on experience in TriZetto FACETS.

Key Responsibilities:

- Process and adjudicate medical claims using TriZetto FACETS.
- Handle pended, rejected, corrected, adjusted, and reprocessed claims.
- Validate member eligibility, benefits, provider details, pricing, and reimbursement.
- Handle claims workflow, exceptions, rework, and escalations.
- Work with BlueCard/shared administration workflows.
- Ensure compliance with HIPAA and payer guidelines.
- Meet defined quality, productivity, SLA, and compliance targets.

Must-Have Skills:

- TriZetto FACETS – Claims Processing
- HIPAA
- ICD-10-CM
- Claims Management
- Provider Data Management
- US Healthcare Payer / Healthcare BPM-BPO experience

Qualification: Graduate
Preferred: B.Tech / MCA / BCA / M.Sc IT / B.Sc IT

Interested candidates can share their CV at:
[email protected]

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