BPM Product Configuration Lead

Role & responsibilities

Configuration Leadership Lead end-to-end product, group, account, and benefit configuration activities within TriZetto Facets. Manage implementation of new group setups, renewals, amendments, and maintenance requests. Provide oversight for configuration analysts, BPM associates, QA analysts, and cross-functional teams. Ensure adherence to implementation timelines, project milestones, and operational SLAs. Coordinate configuration releases, deployments, and production readiness activities. BPM & Operational Excellence Drive business process management initiatives to improve configuration accuracy, efficiency, and productivity. Analyze, document, and optimize configuration workflows and operational processes. Develop and maintain SOPs, process maps, operational controls, and knowledge repositories. Identify process improvement opportunities using Lean, Six Sigma, and continuous improvement methodologies. Monitor operational metrics and establish governance mechanisms to ensure process compliance. Support transition, migration, and stabilization activities for configuration operations. Functional Oversight Review and interpret Portfolio Detail Reports (PDRs), benefit documents, contracts, and group setup requirements. Ensure accurate translation of business requirements into TriZetto Facets configurations. Resolve complex configuration scenarios involving benefit structures, eligibility rules, accumulators, provider networks, and pricing dependencies. Provide guidance on healthcare product design, configuration standards, and BPM best practices. Governance & Quality Establish configuration standards, quality controls, audit requirements, and BPM governance frameworks. Conduct quality reviews, calibration sessions, and process audits. Lead root cause analysis for configuration defects, process gaps, and production issues. Monitor defect trends and implement preventive and corrective actions. Ensure compliance with regulatory, contractual, business, and operational requirements. Stakeholder Management Partner with Product, Underwriting, Enrollment, Claims, Operations, BPM teams, and IT stakeholders. Serve as the primary escalation point during group implementations and renewals. Participate in governance meetings, operational reviews, and status discussions. Support business readiness, operational stabilization, and continuous improvement initiatives. Continuous Improvement Drive process standardization, documentation enhancements, and best-practice adoption. Identify automation opportunities to reduce manual effort, defects, and turnaround times. Support AI-enabled configuration validation, workflow automation, and testing initiatives. Improve delivery efficiency through workflow optimization and operational excellence programs.

Preferred candidate profile

Bachelor's degree in Business, Healthcare Administration, Information Systems, Engineering, or a related field.

• Experience 8+ years of healthcare payer configuration and BPM operations experience.
• Minimum 3+ years in a Lead, Supervisory, or Operations Management role.
• Experience supporting Commercial, ACA, Medicare, and/or Medicaid products
• Experience with large-scale group implementations, renewals, and operational process management.
• Experience in healthcare payer BPM environments, shared services, or managed services operations is preferred.
• Required Platform Hands-on expertise in TriZetto Facets product, benefit, and group configuration.
• Key Performance Indicators (KPIs) Configuration accuracy rate First-pass quality Implementation success rate Production defect leakage SLA adherence Configuration turnaround time Customer satisfaction Audit compliance score Process efficiency improvement Productivity and operational excellence metrics