Facets Configuration Lead: Claims, Benefits & Adjudication

Healthcare IS; United States; Presencial; USD 110.000 - 170.000; Jornada completa

Descripción de la vacante

Healthcare IS is seeking a Facets Configuration Subject Matter Expert to lead complex configuration initiatives across claims, benefits, provider, pricing and workflow modules. You will translate contract terms into system-ready specifications and ensure accurate adjudication.

You will collaborate with Claims, Finance, IT and delegated risk teams to maintain configurations, perform UAT and regression testing, and drive configuration optimization across payer, IPA and MSO environments.

Formación

• 5+ years of hands-on Facets configuration across multiple subsystems (Benefits, Provider, Workflow, Claims).
• Strong understanding of claims adjudication, benefit interpretation, reimbursement methods.
• Experience in payer, IPA, MSO, or delegated-risk environments.
• Track record supporting upgrades, releases, or new implementations.
• Strong analytical, problem-solving and documentation skills.
• Excellent communication across technical and non-technical stakeholders.

Responsabilidades

• Lead end-to-end Facets configuration across Benefits, Provider, Claims, Pricing and Workflow components.
• Translate contract terms and payment models into configuration specs.
• Collaborate with Claims, Finance, Provider Contracting, Delegation Oversight, Enrollment and IT.
• Perform configuration testing: UAT, regression, scenario-based adjudication.
• Support integrations with pricing engines, delegated data exchanges, and reporting datasets.
• Maintain configuration docs, version control, and process playbooks.
• Advise on best practices, strategy and optimization for Facets configurations.

Conocimientos

Facets configuration

Claims adjudication

Benefit interpretation

Provider contract logic

Payer/IPA/MSO knowledge

Analytical skills

Documentation

Cross-functional collaboration

Descripción del empleo

Healthcare IS is seeking a Facets Configuration Subject Matter Expert to lead complex configuration initiatives across claims, benefits, provider, pricing and workflow modules. You will translate contract terms into system-ready specifications and ensure accurate adjudication.

You will collaborate with Claims, Finance, IT and delegated risk teams to maintain configurations, perform UAT and regression testing, and drive configuration optimization across payer, IPA and MSO environments.