Healthcare Pricing & Policy Configuration Specialist

HCL Technologies Limited; Rhode Island; On-site; USD 120,000 - 170,000; Full time

Job summary

HCL Technologies Limited in the United States is seeking an experienced Facets configuration expert to implement and maintain pricing, policy, and workflow components. You will ensure pricing rules, provider contracts, and MPP align with contractual agreements while delivering accurate configuration across all facets modules.

The role requires strong analytical skills, attention to detail, and effective stakeholder management to translate business requirements into scalable system settings and

Qualifications

• 5+ years of experience in Facets Benefit, Pricing or workflow.
• Strong expertise in pricing modules, medical policy, ITS, and workflow module.
• Solid understanding of US healthcare claims.

Responsibilities

• Configure, maintain, and support Facets Pricing components to reflect contractual agreements.
• Set pricing logic for Professional, Facility, and Ancillary claims; implement DRG/APC/Per Diem pathways.
• Translate business requirements into system configurations within Facets.
• Interpret and implement medical policies; configure edits aligned with guidelines.
• Support ITS scenarios and ensure BlueCard compliance; troubleshoot claims.
• Configure workflow overrides and pendings; perform unit, SIT and UAT testing; validate outcomes.

Skills

Analytical thinking

Attention to detail

Stakeholder management

Strong communication

Tools

Facets pricing system

ITS system

Workflow module

Job description

HCL Technologies Limited in the United States is seeking an experienced Facets configuration expert to implement and maintain pricing, policy, and workflow components. You will ensure pricing rules, provider contracts, and MPP align with contractual agreements while delivering accurate configuration across all facets modules.

The role requires strong analytical skills, attention to detail, and effective stakeholder management to translate business requirements into scalable system settings and