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
