Facets Healthcare Architect: Claims & Data Integration

HCL Technologies Limited; San Antonio (TX); Presencial; USD 94.000 - 139.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical insurance

Dental insurance

Vision insurance

Pharmacy coverage

Life insurance

Disability insurance

401(k) retirement plan

PTO 10 days

10 holidays per year

Descripción de la vacante

HCLTech in Texas seeks a seasoned Technical Architect with strong TriZetto Facets experience to lead healthcare payer solutions. You will design and implement Facets modules for claims processing, benefits configuration, and member/provider management, including ACA and Medicare programs, while coordinating with business and technical teams.

Role requires collaboration with PBM vendors, integration work, data analysis (SQL), and API integrations to support regulatory changes and transformation

Formación

• Experience with TriZetto Facets and healthcare claims processing.
• Strong knowledge of benefits configuration and member/provider management.
• Experience with ACA, Medicare programs and regulatory changes.
• Experience integrating with PBM vendors and healthcare data systems.
• Proficiency in SQL, data analysis, and API integrations within healthcare payers.

Responsabilidades

• Gather and analyze business requirements from healthcare stakeholders.
• Work extensively with TriZetto Facets modules.
• Support Claims Adjudication and Payment processing.
• Configure and validate Benefits, Accumulators, and Provider contracts.
• Analyze Member enrollment and eligibility processes.
• Collaborate with PBM vendors for Pharmacy benefit integrations.
• Support ACA Marketplace and Medicare business processes.
• Perform impact analysis for system enhancements and regulatory changes.
• Create BRDs, FRDs, User Stories, Process Flows, and Test Cases.
• Coordinate UAT and production implementation activities.
• Work closely with development, QA, and operations teams.

Conocimientos

Data Analysis

SQL

MS Excel

Agile / Scrum

API Integrations

Herramientas

Jira

Confluence

HP ALM / Quality Center

Descripción del empleo

HCLTech in Texas seeks a seasoned Technical Architect with strong TriZetto Facets experience to lead healthcare payer solutions. You will design and implement Facets modules for claims processing, benefits configuration, and member/provider management, including ACA and Medicare programs, while coordinating with business and technical teams.

Role requires collaboration with PBM vendors, integration work, data analysis (SQL), and API integrations to support regulatory changes and transformation