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AI Summary
The analyst is responsible for configuring and maintaining Facets system rules, benefits, and operational parameters to ensure accurate claims adjudication. They will also collaborate with cross-functional teams to troubleshoot configuration issues and support system optimizations.
This is a remote position.
We are seeking an experienced Facets Configuration Analyst to support the configuration, maintenance, and optimization of the Facets platform. This role is responsible for ensuring accurate claims adjudication by building and maintaining system rules, benefit plans, and operational parameters in alignment with business and regulatory requirements.Key Responsibilities:
- Configure and maintain Facets system rules, benefits, and parameters to support claims processing and operational workflows
- Ensure accurate and compliant claims adjudication through proper system configuration
- Translate business and regulatory requirements into effective system solutions
- Analyze and troubleshoot configuration issues, identifying root causes and implementing resolutions
- Collaborate with cross-functional teams including operations, compliance, and IT to support system updates and enhancements
- Maintain documentation related to configurations, processes, and system changes
- Support ongoing system optimization and performance improvements
Requirements
Required Qualifications:
- Minimum of 5 years of hands-on experience with the Facets platform
- At least 3 years of experience working with CMS work products, including Medicare Advantage (MA) or Medicaid
- Proficiency in a minimum of three Facets modules, including Facets Medical Plan
- Experience working with Facets version 25.1 or newer
- Strong understanding of healthcare payer operations and claims adjudication processes
- Excellent communication skills, both written and verbal
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