SME-Configuration HC

Job Summary

Serve as a subject matter expert in health care benefit configuration with a primary focus on Facets benefit configuration for a multinational organization. Apply four to seven years of hands on experience to design configure validate and optimize benefit solutions that enhance member experience and operational accuracy. Operate in a night shift work from office model ensuring stable production support and continuous improvement of benefit configuration outcomes.

Responsibilities

• Configure complex health care benefits in Facets benefit configuration to ensure accurate enrollment processing and claims adjudication that align with client contractual requirements and regulatory guidelines.
• Analyze benefit requirements and source documentation to translate business rules into precise configuration specifications that reduce defects and rework across downstream administrative processes.
• Validate existing and newly configured benefits through detailed scenario based testing and impact analysis to confirm that calculated results align with expected outcomes and organizational quality standards.
• Collaborate with business analysts and operations teams to clarify benefit intent and configuration rules so that benefit designs are implemented consistently and support a seamless member and provider experience.
• Document configuration design decisions benefit rules and exception handling in a clear and reusable format to support future maintenance knowledge transfer and audit readiness.
• Perform root cause analysis for configuration related issues reported by stakeholders to identify defects or gaps and implement targeted corrections that prevent recurrence and stabilize production performance.
• Optimize benefit configuration structures by simplifying rules removing redundancies and aligning configuration patterns with enterprise standards to improve system maintainability and processing efficiency.
• Coordinate and execute configuration migration activities across non production and production environments while following change control procedures to minimize risk and ensure traceability.
• Provide subject matter guidance to peers and partner teams on Facets benefit configuration capabilities limitations and best practices to improve solution design quality and reduce implementation cycles.
• Engage in periodic regression testing of benefit configurations during system upgrades and patch deployments to detect configuration impacts early and safeguard critical business functions.
• Prepare and review configuration related metrics such as defect trends turnaround times and accuracy rates to identify opportunities for continuous improvement and to demonstrate value delivered to the organization.
• Support night shift operational activities by monitoring critical configuration driven processes addressing incidents promptly and communicating status updates to relevant stakeholders when required.
• Contribute to initiatives that enhance member and provider satisfaction by configuring benefits that are transparent predictable and aligned with the company purpose of improving health care outcomes for communities.
  
  

Qualifications

• Apply four to seven years of practical experience in Facets benefit configuration and health care benefits configuration to independently handle end to end configuration tasks with minimal supervision.
• Utilize strong knowledge of health plan products cost sharing structures and benefit accumulators to design configurations that accurately represent complex benefit designs.
• Use working knowledge of claims processing enrollment processing and eligibility concepts to anticipate configuration impacts and proactively prevent operational issues.
• Communicate in English at a novice professional level in both spoken and written form to collaborate effectively with team members and accurately document configuration assets.
• Leverage analytical thinking attention to detail and problem solving skills to interpret business rules validate edge cases and deliver reliable configuration outcomes.
• Demonstrate familiarity with testing practices such as test case creation defect documentation and result reconciliation related to benefit configuration validation.
• Adapt successfully to a work from office night shift environment by maintaining consistent productivity focus and responsiveness to time sensitive configuration requests.
  
  

Certifications Required

Preferred certification in health care administration or Facets configuration training completion