Facets Claims Expert: Complex Processing & COB

Healthcare IS; United States; On-site; USD 55,000 - 85,000; Full time

Job summary

Healthcare IS is seeking experienced Facets Claims Examiners to support a large payer with processing complex healthcare claims operations. The role requires hands-on processing within the Facets platform, including COB claims and interpretation of benefits and payment rules.

Ideal candidates will have strong attention to detail, the ability to work in a production-driven environment, and clear written and verbal communication.

Qualifications

• Hands-on experience as a Facets Claims Examiner with advanced Facets knowledge.
• Experience processing Coordination of Benefits (COB) claims.
• Ability to analyze claim details and determine accurate processing decisions.
• Clear written and verbal communication in a deadline-driven environment.

Responsibilities

• Manually review, evaluate, and process healthcare claims within the Facets platform.
• Research and resolve complex claim scenarios requiring interpretation of benefits and rules.
• Validate primary/secondary payer responsibility in COB claims.
• Identify discrepancies and document processing decisions.
• Escalate issues when additional review is required.
• Collaborate with team and client stakeholders to support timely resolution.

Skills

Facets Claims Processing

COB processing

Claim analysis

Attention to detail

Communication skills

Production environment

Job description

Healthcare IS is seeking experienced Facets Claims Examiners to support a large payer with processing complex healthcare claims operations. The role requires hands-on processing within the Facets platform, including COB claims and interpretation of benefits and payment rules.

Ideal candidates will have strong attention to detail, the ability to work in a production-driven environment, and clear written and verbal communication.