Facets Configuration Sr. Lead

Role & responsibilities

BPM Configuration Lead 8+ years of Healthcare Payer and BPM experience with strong understanding of Claims, Enrollment, Billing, Provider, and Benefit Administration processes. Hands-on TriZetto FACETS Configuration experience, including Product Configuration, Group Setup, Benefits Configuration, and Claims Adjudication Rules. Proven experience configuring: Product Shells & Finals Benefit Plans BQT Templates Deductibles, Copays, Coinsurance Network and Service Payment Rules Group, Subgroup, Class Plan, and Billing Structures. Strong knowledge of FACETS Claims Processing, Benefit Interpretation, and Configuration-driven Adjudication. Experience leading Configuration Analysts and cross-functional teams, including work planning, mentoring, reviews, and stakeholder management. Experience working in Healthcare BPM/BPO environments, supporting operational excellence, process governance, SLA adherence, and continuous improvement initiatives. Working knowledge of Healthcare EDI transactions (834/837), SQL, ServiceNow, Azure DevOps, and configuration migration processes. Strong understanding of HIPAA, healthcare compliance, audit controls, and quality standards. Excellent communication and stakeholder management skills with the ability to translate business requirements into FACETS configuration solutions. Preferred: FACETS Certification and prior experience supporting large-scale healthcare payer implementations and transformations. Experience in Healthcare BPM operations and process transformation initiatives is highly preferred.

Preferred candidate profile

We will listen, learn, be empathetic and help selflessly in our interactions with everyone.

We honour our commitments and act with responsibility in all our relationships

Equal Opportunity Employer. We believe that no one should be discriminated against because of their differences, such as age, disability, ethnicity, gender, gender identity and expression, religion, or sexual orientation.

All employment decisions shall be made without regard to age, race, creed, colour, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.