Facets Claims Benefit Consultant

TechDigital Group; Portland (OR); On-site; USD 80,000 - 100,000; Full time

Job summary

A leading tech consulting firm is seeking a Facets Claims Benefit Consultant. The role involves providing application expertise in claims and benefits within the Facets platform, conducting client sessions to establish operational practices, and collaborating with varying resource models. Key responsibilities include advanced analysis of claims operations and liaising with technical groups. Ideal candidates will have strong knowledge of Facets application and benefit data structures, alongside excellent problem-solving capabilities.

Qualifications

• Strong understanding of Facets core application functionality.
• Expert knowledge in benefit-costs and type of service mapping.
• Experience with claims root cause analysis.

Responsibilities

• Provide advanced analysis and problem-solving related to claims operations.
• Liaise with business and technical groups to transfer knowledge.
• Articulate issues and provide alternative solutions.

Skills

Facets application expertise

Claim analysis

Benefit-cost knowledge

Problem-solving skills

Tools

Facets

Job description

Top 3 Must-Haves

1. Strong understanding of the Facets core application functionality, especially benefit structures and claims operations process flows.
2. Expert knowledge in benefit-costs and type of service mapping, limits, and accumulators.
3. Experience with claims root cause analysis, benefits cost shares, PCA, and Workflow to solve.

Job Description

A Facets Claims Benefit Consultant is responsible for providing customers with application domain expertise related to claims and benefits functionality within the Facets platform. The consultant will conduct requirements discovery sessions with clients to determine outcomes, KPIs, and operational practices for benefits and claims. The role requires excellent general consulting and Facets application skills and may require remote participation.

Key Responsibilities

• Provide advanced analysis, problem-solving, and interpret application configuration.
• Emphasize benefit structures related to evidence of coverage, claims operations process flows, and best practices in end-to-end design on claims/benefits value chains.
• Apply expert knowledge in benefit-costs, type of service mapping, limits, and accumulators.
• Liaison effectively with business and technical groups, transferring Facets application knowledge to client staff.
• Clearly articulate (both verbal and written) issues and provide alternative solutions.
• Work effectively with onshore/offshore resource models.

Preferred Experience

• Commercial large implementation experience with Facets.
• Multiple TriZetto implementation roles.
• Experience solving benefit cost share and type of service mapping.
• Strong knowledge of Facets benefit data structures.