Claim Processor

Growel Softech Pvt. Ltd.; Chennai District, Bengaluru, Thiruvananthapuram; On-site; INR 600,000 - 900,000; Full time

Job summary

Growel Softech Pvt. Ltd. is hiring a Claims Processor US Healthcare Payer skilled in TriZetto FACETS to process and adjudicate medical claims. This role requires HIPAA adherence, ICD-10-CM proficiency, and experience with US payer workflows.

Night shift in India is common for this position. Location options include Chennai, TVM, or Bangalore, with a focus on accuracy, data integrity, and adherence to SLAs. Graduate degrees are required; IT graduates are preferred for growth in BPM-BPO

Qualifications

• Graduation is required; higher IT degrees preferred.
• Experience in US healthcare payer/BPM-BPO is required.
• Strong FACETS, HIPAA and ICD-10-CM knowledge.

Responsibilities

• Process and adjudicate medical claims using FACETS.
• Handle pended, rejected, corrected, and reprocessed claims.
• Validate member eligibility, benefits, provider data, pricing.
• Ensure HIPAA compliance and meet quality targets.
• Work with BlueCard/shared administration workflows.

Skills

FACETS Claims

HIPAA

ICD-10-CM

Claims Management

Provider Data Mgmt

US Healthcare Payer

Education

Graduate

B.Tech / MCA / BCA / M.Sc IT / B.Sc IT (preferred)

Job description

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 strong 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