FACETS Claims Operations Lead – Transformation & Governance

Envision Technology Solutions

Seattle (WA)

On-site

USD 180,000 - 240,000

Full time

2 days ago

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Job summary

Envision Technology Solutions seeks an experienced leader to drive end-to-end FACETS Claims Operations transitions and ongoing delivery in the healthcare payer space. You will partner with client executives to manage governance forums, risk reviews, and service delivery, while guiding cross-functional teams to optimize processing and outcomes.

Ideal candidates bring 10+ years in healthcare payer operations, deep FACETS expertise, and a track record of successful transition programs.

Qualifications

10+ years in Healthcare Payer Operations and BPM/BPO Operations.
Deep expertise in FACETS Claims Processing and Adjudication.
Proven experience leading large-scale transition, transformation, and managed services engagements.
Strong stakeholder management, governance, and leadership capabilities.

Responsibilities

Lead the end-to-end transition and operational delivery of FACETS Claims Operations, ensuring knowledge acquisition, readiness, and steady-state handoff.
Act as the primary client-facing lead and trusted advisor for Claims Operations, managing executive stakeholder relationships, governance forums, risk reviews, and decision-making.
Oversee FACETS claims adjudication operations, ensuring productivity, quality, turnaround time, and SLA commitments.
Establish governance, metrics, dashboards, and controls to monitor performance and drive continuous improvement.
Collaborate with Enrollment, Provider Operations, Configuration, Application Support, and Technology teams to drive end-to-end process effectiveness.
Provide leadership to onshore and offshore operations teams and support workforce planning and capacity management.