Associate III - BPM-E&B QA Analyst

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 .

EB QA Analyst Role Summary The Enrollment Billing (EB) 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 Enrollment Quality Audits - 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. Billing Quality Audits - 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. Documentation Compliance Validation - 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. Defect Analysis Calibration - 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. Reporting Operational Support - Maintain QA scorecards, audit trackers, defect logs, and trend reporting. - Provide actionable insights to the EB Lead, operations, training, SMEs, and compliance partners. - Validate corrective actions and monitor defect recurrence. - Support complex-case reviews while maintaining appropriate QA independence. Mandatory Skills Competencies - 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. Qualifications Education - Bachelors 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. Required Platform - Hands-on experience auditing enrollment and billing transactions in TriZetto Facets. Key Performance Indicators (KPIs) - 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

Humility:

Humanity:

Integrity:

Equal Employment Opportunity Statement

FACETS, EDI 834, Healthcare Systems, Enrollment