osition SummaryThe Facets Configuration Analyst is responsible for the design, configuration, testing, implementation, and maintenance of the Facets core claims processing system. This role collaborates with business stakeholders, operations teams, and IT partners to translate business requirements into system configurations that support health plan administration, claims processing, provider management, and benefit administration functions.
The ideal candidate possesses strong healthcare payer experience, deep knowledge of the Facets platform, and the ability to analyze complex business processes and implement effective system solutions.
Key Responsibilities- Configure and maintain Facets modules including benefits, providers, products, contracts, pricing, claims, and eligibility.
- Analyze business requirements and translate them into detailed configuration specifications.
- Collaborate with business analysts, project managers, developers, and operational teams to ensure accurate system implementations.
- Perform impact assessments for requested configuration changes and system enhancements.
- Develop and execute test plans, test scenarios, and validation activities to ensure system accuracy and compliance.
- Troubleshoot configuration issues and participate in root cause analysis for production incidents.
- Support system upgrades, implementations, conversions, and integration projects.
- Document configuration designs, business rules, workflows, and technical procedures.
- Ensure compliance with regulatory requirements and healthcare industry standards.
- Participate in user acceptance testing (UAT) and support end users during implementation activities.
- Monitor system performance and recommend process improvements to optimize efficiency and accuracy.
- Provide ongoing production support and maintenance for Facets applications.
Required Qualifications- Bachelor's degree in Information Technology, Healthcare Administration, Business, or related field; equivalent experience may be considered.
- 3+ years of experience working with the TriZetto Facets platform.
- Experience configuring one or more Facets modules including:
- Benefits
- Claims
- Provider
- Products
- Eligibility
- Pricing
- Knowledge of healthcare payer operations and claims processing.
- Experience gathering and analyzing business requirements.
- Strong analytical, problem-solving, and troubleshooting skills.
- Experience with testing methodologies and defect management.
- Excellent written and verbal communication skills.
- Ability to manage multiple priorities in a fast-paced environment.
Preferred Qualifications- 5+ years of Facets configuration experience.
- Experience with Medicare, Medicaid, Commercial, or Exchange products.
- Knowledge of EDI transactions including 834, 835, 837, and 278.
- Experience with SQL for data analysis and validation.
- Familiarity with healthcare regulations, including HIPAA.
- Experience working in Agile or Scrum environments.
