Facets Configuration Subject Matter Expert (SME) with deep expertise across core Facets modules. This SME will support complex configuration initiatives across claims, provider/payment arrangements, benefit structures, and financial responsibility allocations. The role plays a critical part in ensuring accurate adjudication, operational efficiency, and compliance across payer, IPA, and delegated models.
Key Responsibilities:
Lead end‑to‑end Facets configuration, including Benefits, Provider, Claims, Pricing, and Workflow components, ensuring accurate system behavior and alignment with business rules.
Interpret and translate contract terms, plan documents, and organizational payment models into system‑ready configuration specifications.
Collaborate closely with internal business teams—Claims, Finance, Provider Contracting, Delegation Oversight, Enrollment, and IT—to ensure configuration accuracy, alignment, and traceability.
Perform configuration testing: UAT, regression, scenario‑based adjudication, and impact analysis.
Support downstream and upstream integrations, including pricing engines, delegated entity data exchanges, and reporting datasets.
Maintain configuration documentation, version control, job aids, and process playbooks.
Serve as a senior advisor, offering guidance on Facets best practices, configuration strategy, and optimization.
Required Qualifications:
5+ years of hands‑on Facets configuration experience across multiple subsystems (e.g., Benefits, Provider, Workflow, Claims).Strong understanding of claims adjudication, benefit interpretation, reimbursement methodologies, and provider contract logic.
Experience working in payer, IPA, MSO, or delegated-risk environments.
Demonstrated experience supporting system upgrades, release cycles, or new implementation initiatives.
Strong analytical, problem‑solving, and documentation skills.
Excellent communication skills, with the ability to collaborate across technical and nontechnical stakeholders.
