Claim Processor

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

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