Associate III - BPM-E&B QA Analyst

UST; Thiruvananthapuram; On-site; INR 1,800,000 - 2,600,000; Full time

Job summary

UST is seeking an Enrollment & Billing (E&B) QA Analyst to audit enrollment and billing transactions in TriZetto Facets. The role ensures accuracy, completeness, and adherence to procedures and regulatory controls, with focus on 834 processing, eligibility, and payment reconciliation.

The ideal candidate has a strong QA mindset, analytical skills, and hands-on experience with TriZetto Facets in a US healthcare payer context.

Qualifications

• Bachelor's degree or equivalent relevant experience.
• 5+ years in US healthcare payer enrollment, eligibility, membership, or billing operations.
• Minimum 2+ years in QA, audit, or quality control.
• Experience auditing high-volume, SLA-driven healthcare transactions.

Responsibilities

• Audit new enrollments, member additions, demographic changes, subgroup moves, removals, and terminations in TriZetto Facets.
• Validate member eligibility and enrollment documents for completeness and accuracy.
• Review corrections to fallout from employer portals, BenefitFocus Enrollment Center, reports, and 834 files.
• Validate Medicare Supplement enrollment maintenance and spousal discount eligibility transactions.

Skills

EDI 834

FACETS

Enrollment

TriZetto

Education

BTech/ MCA/ BCA/ MSc IT/ BSc IT

Tools

TriZetto Facets

Job description

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….
E&B QA Analyst Role Summary The Enrollment & Billing (E&B) QA Analyst is responsible for independently auditing enrollment and billing transactions completed in TriZetto Facets. The role validates eligibility, member maintenance, 834 fallout resolution, billing reconciliation, payment reallocations, communications, and supporting documentation to ensure accuracy, completeness, procedural compliance, and defect prevention.

Key Responsibilities

• Audit new enrollments, member additions, demographic changes, subgroup moves, removals, and terminations completed in TriZetto Facets.
• Validate member eligibility and enrollment documents for completeness and accuracy.
• Review corrections to fallout from employer portals, BenefitFocus Enrollment Center, reports, and 834 files.
• Validate Medicare Supplement enrollment maintenance and spousal discount eligibility transactions when assigned.
• Audit cash receipt review and subgroup reallocations recorded in TriZetto Facets.
• Validate member-level reconciliation of billed and paid amount variances.
• Review terminated-group balances, returned payments, COBRA-related reports, pending-claims reports, and other assigned billing work.
• Validate National Accounts billing and reconciliation transactions against source reporting.
• Confirm that source documents, calculations, case notes, communications, and supporting evidence are complete and securely retained.
• Verify adherence to approved desktop procedures, service levels, and regulatory or audit controls.
• Identify missing evidence, data discrepancies, financial-impact errors, and cases requiring escalation.
• Support client, compliance, and operational audit readiness.
• Classify defects by process, complexity tier, root cause, and business impact.
• Conduct root cause analysis across process, knowledge, documentation, source data, and system factors.
• Participate in calibration sessions to maintain consistent scoring and interpretation.
• Recommend corrective actions, refresher training, and preventive controls.
• Maintain QA scorecards, audit trackers, defect logs, and trend reporting.
• Provide actionable insights to the E&B Lead, operations, training, SMEs, and compliance partners.
• Validate corrective actions and monitor defect recurrence.
• Support complex-case reviews while maintaining appropriate QA independence.
• Strong quality assurance knowledge across healthcare payer enrollment and billing operations.
• Hands-on knowledge of TriZetto Facets enrollment and billing workflows.
• Knowledge of eligibility, member maintenance, 834 processing, billing reconciliation, receipt reallocation, and enrollment documentation.
• Strong analytical, audit, root cause analysis, financial-detail review, and reporting skills.
• Ability to consistently apply audit standards and explain findings clearly.
• Bachelor's degree or equivalent relevant experience. Experience
• 5+ years in US healthcare payer enrollment, eligibility, membership, or billing operations.
• Minimum 2+ years in QA, audit, or quality control.
• Experience auditing high-volume, SLA-driven healthcare transactions.
• Hands-on experience auditing enrollment and billing transactions in TriZetto Facets.
• Audit accuracy
• Defect detection and classification accuracy
• Defect leakage rate
• Calibration consistency
• Audit completion turnaround time
• Corrective-action effectiveness
• Documentation and audit pass rate
• Repeat-defect reduction

What You Need

BTech/ MCA/ BCA/Msc IT/Bsc IT

Required Skills

EDI 834, FACETS, Enrollment, TriZetto

What You Need

What we believe

We’re proud to embrace the same values that have shaped UST since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone, to champion diversity and inclusion and to place people at the centre of everything we do.

Humility

We will listen, learn, be empathetic and help selflessly in our interactions with everyone.

Humanity

Through business, we will better the lives of those less fortunate than ourselves.

Integrity

We honour our commitments and act with responsibility in all our relationships.

Equal Employment Opportunity Statement

UST is an Equal Opportunity Employer. We believe that no one should be discriminated against because of their differences, such as age, disability, ethnicity, gender, gender identity and expression, religion, or sexual orientation.

All employment decisions shall be made without regard to age, race, creed, colour, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

UST reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

• To support and promote the values of UST.
• Comply with all Company policies and procedures

Skills

FACETS, EDI 834, Healthcare Systems, Enrollment

Skills

• EDI 834, FACETS, Enrollment, TriZetto