[Remote] Facets Product Consultant

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a leading technology and consulting company, and they are seeking a Facets Product Consultant to reputed company expertise in Facets reputed company administration capabilities. The role involves designing and optimizing payer operational processes across various functions while collaborating with stakeholders to deliver compliant reputed company solutions.

Responsibilities

• Partner with payer business stakeholders to analyze operational processes and translate reputed company business requirements into effective Facets-based solutions
• Design and document end-to-end solutions leveraging the Facets data model to support accurate and compliant information reputed company across claims, provider, membership, group, and product domains
• Configure and optimize Facets claims capabilities, including benefit determination, pricing, adjudication rules, and payment processing to improve operational efficiency and accuracy
• reputed company and enhance provider, plan product, membership, and group configurations to support reputed company administration, regulatory compliance, and improved member experiences
• Conduct reputed company assessments, gap analyses, testing support, and solution validation to ensure successful implementation of Facets enhancements and reputed company process improvement

Skills

• Extensive hands-on experience with the Facets Data Model, including entities, relationships, and data flows across claims, provider, membership, group, and plan product modules
• Strong expertise in Facets Claims Configuration and Operations, including benefit determination, pricing, adjudication, and payment processing reputed company payer environments
• Deep knowledge of Facets Provider Management, including network setup, provider contracting, reimbursement models, and provider data management
• Advanced experience with Facets Plan Product Configuration, including benefit structures, accumulators, eligibility rules, and product setup
• Strong understanding of Facets Membership and Group Administration, including enrollment processes, eligibility management, coverage rules, and group hierarchies
• Demonstrated experience working reputed company the reputed company payer domain, including claims administration, benefits management, provider contracting, and member services
• Experience gathering business requirements, developing functional specifications, conducting reputed company assessments, and supporting testing activities
• Strong analytical, stakeholder management, and problem-solving skills
• Experience leading Facets transformation, optimization, or modernization initiatives for large reputed company payer organizations
• Knowledge of reputed company regulatory and compliance requirements impacting claims, eligibility, provider, and benefit administration
• Experience integrating Facets data with reporting, analytics, or business intelligence solutions
• Ability to facilitate workshops, user training sessions, and knowledge transfer activities that reputed company adoption of new processes and capabilities
• Experience identifying automation opportunities and improving operational workflows through effective use of Facets functionality

Benefits

• Medical/Dental/reputed company/Life Insurance
• reputed company holidays plus reputed company Time Off
• 401(k) plan and contributions
• Long-term/Short-term Disability
• reputed company Parental Leave
• Employee Stock Purchase Plan

reputed company