Claims Operations (FACETS) Lead

Sophus IT Solutions; Bellevue (WA); Hybrid; USD 140,000 - 180,000; Full time

Job summary

Sophus IT Solutions seeks a Manager I BPM - Claims Operations (FACETS) Lead in Bellevue, WA. This hybrid role oversees end-to-end FACETS Claims Operations, ensuring readiness, governance, and successful delivery across onshore and offshore teams.

Top candidates will have 10+ years in healthcare payer operations and BPM/BPO, with proven transition and managed services leadership. Strong stakeholder management and SLA discipline are essential for driving performance and customer outcomes.

Qualifications

• 10+ years of Healthcare Payer Operations and BPM/BPO Operations experience with deep expertise in FACETS Claims Processing and Adjudication.
• Proven experience leading large-scale transition, transformation, and managed services engagements.
• Strong understanding of Commercial, Medicare, Medicaid, and Government Programs claims operations.
• Demonstrated success managing client relationships, operational governance, service delivery, and cross-functional teams.
• Experience managing large-scale onsite/offshore BPM delivery teams.
• Strong knowledge of SLA management, productivity management, operational governance, workforce management, and continuous improvement methodologies.
• Excellent communication, stakeholder management, and leadership skills.

Responsibilities

• Lead end-to-end transition and operational delivery of FACETS Claims Operations, ensuring knowledge acquisition, readiness, stabilization, and steady-state support.
• Act as the primary client-facing lead and trusted advisor for Claims Operations, managing executive stakeholder relationships, governance forums, risk reviews, and operational decision-making.
• Partner with client SMEs and business leaders to assess current-state operations, define future-state operating models, and establish service delivery frameworks.
• Drive transition planning, knowledge transfer execution, readiness assessments, and operational acceptance activities for handoff to delivery teams.
• Oversee FACETS claims adjudication operations ensuring productivity, quality, turnaround time, and SLA adherence.
• Establish governance processes, performance metrics, reporting dashboards, and controls to monitor operational performance.
• Identify risks, process gaps, dependencies, and improvement opportunities with mitigation plans.
• Collaborate with Enrollment, Provider Operations, Configuration, Application Support, and Technology teams to drive end-to-end process effectiveness.
• Lead continuous improvement, automation, and transformation initiatives to enhance efficiency, quality, customer experience, and business outcomes.
• Provide leadership and coaching to onshore and offshore teams, fostering accountability and collaboration.
• Support workforce planning, capacity management, forecasting, and resource optimization.
• Ensure compliance with healthcare payer regulations, policies, audits, and governance standards.
• Lead Healthcare BPM delivery and operations management with SLA adherence and continuous process improvement.
• Drive BPM transformation initiatives and service delivery optimization across healthcare payer operations.
• Manage BPM/BPO delivery teams, stakeholder governance, performance management, and operational reviews.

Skills

FACETS processing

BPM/BPO operations

Stakeholder management

Leadership

SLA management

Transition leadership

Onsite/Offshore delivery

Job description

Manager I BPM - Claims Operations (FACETS) Lead

Location: Bellevue WA Hybrid

Manager I BPM - Claims Operations (FACETS) Lead Location: United States - Seattle, Washington (No Remote) Employment Type: Full-Time Experience: 10+ Years Open Positions: 1 Experience 10+ Years in Healthcare Payer Operations, BPM Operations, and FACETS Claims Processing

Key Responsibilities

• Lead the end-to-end transition and operational delivery of FACETS Claims Operations, ensuring successful knowledge acquisition, operational readiness, stabilization, and seamless transition to steady-state support.
• Act as the primary client-facing lead and trusted advisor for Claims Operations, managing executive stakeholder relationships, governance forums, risk reviews, and operational decision-making.
• Partner with client SMEs and business leaders to assess current-state operations, define future-state operating models, and establish service delivery frameworks.
• Drive transition planning, knowledge transfer execution, readiness assessments, and operational acceptance activities to ensure a successful handoff to delivery teams.
• Oversee FACETS claims adjudication operations, ensuring adherence to productivity, quality, accuracy, turnaround time, and SLA commitments.
• Establish governance processes, performance metrics, reporting dashboards, and controls to monitor operational performance and deliver continuous visibility to stakeholders.
• Identify operational risks, process gaps, dependencies, and improvement opportunities, implementing mitigation plans and corrective actions to ensure delivery stability.
• Collaborate with cross-functional teams including Enrollment, Provider Operations, Configuration, Application Support, and Technology teams to drive end-to-end process effectiveness.
• Lead continuous improvement, automation, and transformation initiatives to enhance operational efficiency, quality, customer experience, and business outcomes.
• Provide leadership, coaching, and direction to onshore and offshore operations teams, fostering a culture of accountability, collaboration, and operational excellence.
• Support workforce planning, capacity management, forecasting, and resource optimization to align with client demand and business objectives.
• Ensure compliance with healthcare payer regulations, client policies, audit requirements, and operational governance standards.
• Lead Healthcare BPM delivery and operations management, ensuring SLA adherence, productivity targets, quality performance, operational governance, and continuous process improvement.
• Drive BPM transformation initiatives, process standardization, automation opportunities, operational excellence programs, and service delivery optimization across healthcare payer operations.
• Manage Healthcare BPM/BPO delivery teams, stakeholder governance, performance management, and operational reviews to achieve business outcomes and customer satisfaction goals.

Required Qualifications

• 10+ years of Healthcare Payer Operations and BPM/BPO Operations experience with deep expertise in FACETS Claims Processing and Adjudication.
• Proven experience leading large-scale transition, transformation, and managed services engagements.
• Strong understanding of Commercial, Medicare, Medicaid, and Government Programs claims operations.
• Demonstrated success managing client relationships, operational governance, service delivery, and cross-functional teams.
• Experience managing large-scale onsite/offshore BPM delivery teams.
• Strong knowledge of SLA management, productivity management, operational governance, workforce management, and continuous improvement methodologies.
• Excellent communication, stakeholder management, and leadership skills.

Preferred Qualifications

• Experience leading Healthcare BPM transformation programs.
• Exposure to Lean Six Sigma, Process Excellence, Automation, and AI-enabled operational transformation initiatives.
• Knowledge of FACETS and Healthcare Payer operational workflows across Claims, Enrollment, Provider, Billing, and Configuration functions.

Success Measures

• SLA/KPI Compliance C