We are seeking a highly experienced Facets Solution Architect Lead to design, configure, and optimize healthcare systems that support CMS program requirements, benefit structures, and operational workflows. This role will serve as a strategic leader, ensuring system configurations align with federal regulations while supporting scalable and efficient payer operations.
Key Responsibilities:
Lead the design and configuration of the Facets platform to support CMS programs, including Medicare Advantage (MA) and Medicaid
Architect and maintain system rules, benefit structures, and workflows to ensure accurate claims adjudication and operational efficiency
Translate complex business and regulatory requirements into scalable system solutions
Provide technical leadership and guidance across Facets modules and system architecture
Oversee and support integrations between Facets and third-party systems and technologies
Analyze system performance, troubleshoot complex issues, and implement long-term solutions
Collaborate with cross-functional teams including operations, compliance, IT, and external vendors
Ensure system configurations meet compliance standards and evolving regulatory requirements
Maintain documentation for system architecture, configurations, and integrations
Requirements
Required Qualifications:
Minimum of 10 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 at least six Facets modules, including:
Medical Plan
Member
Practitioner
Experience working with Facets version 25.1 or newer
In-depth knowledge of Facets data architecture and underlying infrastructure
Proven experience integrating Facets with third-party technologies and systems
Strong understanding of healthcare payer operations and claims adjudication processes
Excellent communication skills, with the ability to interface with both technical and non-technical stakeholders
