Analyst (Non-Voice)

HCLTech; Rhode Island; On-site; USD 90,000 - 130,000; Full time

Job summary

HCL Technologies Limited in the United States is seeking an experienced Facets Config Analyst to support configuring, maintaining, and optimizing benefit, pricing, and workflow components within the Facets core administration platform.

This role requires strong expertise in healthcare claims benefit setup, contract configuration, medical policies, workflow, and end-to-end claims testing to ensure compliant and efficient system operations across pricing environments.

Qualifications

• 5+ years of experience in Facets Benefit, Pricing or workflow.
• Strong expertise in pricing modules, medical policy, ITS, and workflow module.
• Solid understanding of US healthcare claims.

Responsibilities

• Configure, maintain, and support Facets Pricing components (Fee Schedules, Pricing Rules, Contracts, MPP, Modifiers, Global Periods, Carve-outs).
• Configure pricing logic for Professional, Facility, and Ancillary claims (DRG, APC, Per Diem, Case Rates, Fee-for-Service).
• Interpret and implement medical policies into Facets and configure edits.
• Configure and support ITS scenarios and ensure compliance with BlueCard guidelines.
• Configure override and pend in the workflow module in Facets.
• Analyze and troubleshoot configuration issues related to benefit and pricing; perform Unit, SIT and UAT testing; validate outcomes against contracts, benefits, and policies.

Skills

Analytical thinking

Attention to detail

Strong communication

Stakeholder management

Pricing configuration

Tools

Facets

Job description

We are seeking an experienced Facets Config Analyst to support in configuring, maintaining, and optimizing benefit, pricing, and workflow components within the Facets core administration platform. This role requires strong expertise in healthcare claims benefit set up, contract configuration, medical policies, workflow and end-to-end claims testing.

Key Responsibilities Facets Pricing Configuration

• ü Configure, maintain, and support Facets Pricing components including Fee Schedules, Pricing Rules, Provider Contracts (Professional, Institutional, Ancillary), Multiple Procedure Pricing (MPP), Modifiers, Global Periods, and Carve-outs. Ensure accurate implementation aligned with contractual agreements.
• ü Configure pricing logic for Professional, Facility, and Ancillary claims. Implement methodologies including DRG, APC, Per Diem, Case Rates, and Fee-for-Service. Translate business requirements into system configuration.

Medical Policy Configuration & Support

• ü Interpret and implement medical policies into Facets.
• ü Configure edits and ensure alignment with clinical guidelines.
• ü Support updating quarterly code new code update in facets.

ITS Configuration

• ü Configure and support ITS (Inter-Plan Teleprocessing System) scenarios.
• ü Ensure compliance with BlueCard guidelines. Troubleshoot ITS claims issues and validate Host/Home processing.

Workflow

• ü Configure override, pend in workflow module in facets

Claims & Testing

• ü Analyze and troubleshoot configuration issues related to benefit and pricing.
• ü Perform Unit, SIT and UAT testing.
• ü Validate outcomes against contracts, benefits, and policies.

Required Qualifications

• ü 5+ years of experience in Facets Benefit, Pricing or workflow.
• ü Strong expertise in pricing modules, medical policy, ITS, and workflow module.
• ü Solid understanding of US healthcare claims.

Key Skills

Analytical thinking, attention to detail, strong communication, and stakeholder management.

Work Location

Onshore (USA-based)

Summary

This role ensures implementing correct configuration design by integrating facets benefit, pricing & workflow modules to meet the business requirement.

Job description:

Role Overview

We are seeking an experienced Facets Config Analyst to support in configuring, maintaining, and optimizing benefit, pricing, and workflow components within the Facets core administration platform. This role requires strong expertise in healthcare claims benefit set up, contract configuration, medical policies, workflow and end-to-end claims testing.

Key Responsibilities Facets Pricing Configuration

• ü Configure, maintain, and support Facets Pricing components including Fee Schedules, Pricing Rules, Provider Contracts (Professional, Institutional, Ancillary), Multiple Procedure Pricing (MPP), Modifiers, Global Periods, and Carve-outs. Ensure accurate implementation aligned with contractual agreements.
• ü Configure pricing logic for Professional, Facility, and Ancillary claims. Implement methodologies including DRG, APC, Per Diem, Case Rates, and Fee-for-Service. Translate business requirements into system configuration.

Medical Policy Configuration & Support

• ü Interpret and implement medical policies into Facets.
• ü Configure edits and ensure alignment with clinical guidelines.
• ü Support updating quarterly code new code update in facets.

ITS Configuration

• ü Configure and support ITS (Inter-Plan Teleprocessing System) scenarios.
• ü Ensure compliance with BlueCard guidelines. Troubleshoot ITS claims issues and validate Host/Home processing.

Workflow

• ü Configure override, pend in workflow module in facets

Claims & Testing

• ü Analyze and troubleshoot configuration issues related to benefit and pricing.
• ü Perform Unit, SIT and UAT testing.
• ü Validate outcomes against contracts, benefits, and policies.

Required Qualifications

• ü 5+ years of experience in Facets Benefit, Pricing or workflow.
• ü Strong expertise in pricing modules, medical policy, ITS, and workflow module.
• ü Solid understanding of US healthcare claims.

Key Skills

Analytical thinking, attention to detail, strong communication, and stakeholder management.

Work Location

Onshore (USA-based)

Summary

This role ensures implementing correct configuration design by integrating facets benefit, pricing & workflow modules to meet the business requirement.