Senior Provider Pricing Configuration Lead

CareMore Health Management Services, LLC; San Francisco (CA); On-site; USD 130,000 - 195,000; Full time

Job summary

CareMore Health Management Services, LLC is seeking a Configuration Manager to lead the Configuration team within Provider Setup. The role translates health plan contracts, policies, and pricing into scalable system configurations to support accurate claims adjudication and regulatory compliance.

You will oversee pricing, benefit configuration, and workflow setups in TriZetto Facets, partnering with Data Management, Network Management, and IT to ensure timely claims payment and provider setup

Qualifications

• Bachelor’s degree in Information Technology, Healthcare Administration, Business, or a related field, or equivalent experience.
• 10+ years in healthcare payer operations/technology focusing on claims, pricing, capitation, or benefit configuration.
• 3+ years of direct people-management leading configuration analysts or similar teams.
• Deep knowledge of claims configuration and adjudication logic, provider pricing, CMS schedules, and benefit configuration.
• Experience with SQL-based validation and ROI-focused analytics for configuration defects.
• Experience with platform upgrades, patches, and post-implementation stabilization.

Responsibilities

• Manages and develops Configuration analysts; assigns work; establishes priorities and capacity plans; evaluates performance; and provides coaching and career development.
• Directs daily configuration operations, including intake, prioritization, capacity, SLAs, quality controls, backlog, and large-scale implementations.
• Oversees pricing, capitation, CMS schedules, and benefit configuration within TriZetto Facets and related tools.
• Coordinates dependencies with Provider Data Management, Practitioner Management, Network Management, enrollment, and IT to ensure timely claims payment and provider setup.
• Designs configuration solutions to improve accuracy of auto-adjudication and reduce errors.
• Leads root-cause analysis for processing errors and implements corrective actions across multiple teams.
• Manages change-control, migrations, and post-production validation; ensures audit readiness.
• Plans system upgrades/patches/releases and coordinates vendor changes.
• Serves as SME for TriZetto Facets configuration strategy and advocates for workflow efficiency.

Skills

Configuration management

Leadership

SQL validation

Claims configuration

Provider pricing

CMS fee schedules

TriZetto Facets

Stakeholder collaboration

Education

Bachelor’s degree in IT/Healthcare or related field

Tools

TriZetto Facets

Facets Configuration Management Utility

EDI knowledge (837/835)

Job description

CareMore Health Management Services, LLC is seeking a Configuration Manager to lead the Configuration team within Provider Setup. The role translates health plan contracts, policies, and pricing into scalable system configurations to support accurate claims adjudication and regulatory compliance.

You will oversee pricing, benefit configuration, and workflow setups in TriZetto Facets, partnering with Data Management, Network Management, and IT to ensure timely claims payment and provider setup