TriZetto Facets Claims Lead — End-to-End Adjudication

UST; Taguig; On-site; PHP 600,000 - 1,000,000; Full time

Job summary

UST in the Philippines is seeking a Claims Processor to perform accurate, compliant, end-to-end medical claims adjudication within the TriZetto Facets platform for a U.S. healthcare payer.

Operating in a BPM environment, you will support pended, exception, corrected, and reprocessed claims while ensuring proper application of benefits, pricing logic, provider validation, and payer policies. You will participate in workflow management, review eligibility, workflow status, and COB/TPL scenarios,

Qualifications

• Graduate degree required.
• 5+ years of experience in U.S. healthcare payer claims processing.
• TriZetto Facets experience is mandatory.
• Experience in BPM/shared services/offshore operations preferred.

Responsibilities

• End-to-End Claims Adjudication within TriZetto Facets.
• Review eligibility, benefit coverage, provider data, and routing prior to adjudication.
• Apply pricing methodologies and ensure compliance with HIPAA and payer policies.
• Handle pends, reprocessing, and automation workflows within BPM guidelines.

Education

Graduate degree

Tools

Availity Essentials

Coding references

Job description

UST in the Philippines is seeking a Claims Processor to perform accurate, compliant, end-to-end medical claims adjudication within the TriZetto Facets platform for a U.S. healthcare payer.

Operating in a BPM environment, you will support pended, exception, corrected, and reprocessed claims while ensuring proper application of benefits, pricing logic, provider validation, and payer policies. You will participate in workflow management, review eligibility, workflow status, and COB/TPL scenarios,