Key Responsibilities Mass Claims Adjustment Execution Review and validate incoming requests for mass claim adjustments (typically 50+ affected claims), ensuring completeness, accuracy, and alignment with internal guidelines. Treat each adjustment request as a mini project, managing intake, validation, execution steps, and closure. Create and manage templates for adjustments within the Facets UI, including benefit, pricing, and configuration touchpoints as needed. Process adjustments through Azure DevOps, ensuring traceability, documentation, and timely updates. Perform root cause validation and reconcile claim subsets to verify that the adjustment request aligns with actual claim conditions. Claims Subject Matter Expertise Apply advanced knowledge of Facets claims processing, including benefit applications, pricing tables, accumulators, provider configuration, and backend system behavior. Execute claim adjustments manually and systemically with a deep understanding of how downstream systems and configuration impact results. Identify potential configuration issues, trends, and systemic defects that contribute to mass adjustment demand. Data Analysis & Validation Analyze large data sets to identify impacted claims, validate request criteria, and ensure accuracy before and after adjustment execution. Utilize data tools to confirm that the adjustment logic matches expected claim scenarios and business requirements. Produce clear, logically structured summaries outlining root causes, validation results, and historical trends to reduce repetitive requests. Stakeholder Communication & Collaboration Communicate effectively with requesters, markets, operations teams, and leadership to obtain approvals, clarify requirements, and provide post adjustment summaries. Explain complex claims scenarios, configuration logic, and adjustment rationales in a clear, business friendly way. Partner closely with automation teams to identify process improvement and automation opportunities, reducing manual ticket submissions. Operational Governance & Quality Control Ensure all adjustments follow internal standards, quality expectations, and compliance requirements. Participate in trend analysis discussions and continuous process improvement initiatives across claims operations. Support documentation updates, workflow refinements, and knowledge transfer within the MCA team. ________________________________________ Required Skills & Qualifications Technical & Functional Expertise Must have: Advanced Facets claims processing experience, including claim lifecycle, pricing rules, benefit application logic, and backend workflows. Strong understanding of claim adjustment processes and downstream operational impacts. Experience validating high volume claim scenarios and interpreting adjustment logic. Familiarity with configuration concepts such as: o Benefit plan structures o Pricing/reimbursement tables o Provider and member configuration o Edit logic and adjudication rules Data & Analytical Skills Ability to analyze large claims datasets using Excel or similar tools. Skilled in validating subsets of claims against request criteria and identifying discrepancies. Ability to summarize root causes and trends using data driven analysis. Communication & Collaboration Strong written and verbal communication skills, able to translate technical claims logic into clear business explanations. Experience partnering with operations teams, requesters, markets, or other business units. Ability to manage multiple adjustment initiatives simultaneously with attention to detail and accuracy. Tools & Systems Facets (required) deep operational expertise. Azure DevOps (preferred) for request tracking and workflow management. Microsoft Excel and data validation tools (required)., Project Code :
About the Company
R
ReqRoute,Inc
ReqRoute is a young, vibrant and dynamic recruitment marketing agency focused on providing Recruitment Branding Solutions, HCM Business Consulting; Managed Services to its customers worldwide. No customer is small; we service small businesses to fortune 1000 customers across the globe. Based in the heart of Silicon Valley, we are passionate about building stronger employer brands to help employers attract the best talent.
We differentiate ourselves by our strong value system, commitment to our clients, best practices and a sound industry experience in finding out-performers. ReqRoute develops sustainable relationships based on mutual trust, responsiveness and accountability. While we continue to expand the infrastructure and resources available to our clients, we remain nimble in our approach to customer service and the management of our relationships. We take time to properly understand our client needs and offer a full range of cost effective, client centric solutions to a diverse client base.
We offer flexible delivery methods to help our clients achieve their specific recruitment branding objectives by using our platform. We put you on the driver’s seat by enabling you to track the effectiveness of your recruitment marketing campaign by providing you real time analytics that helps you make changes to strategies and reallocate budgets.
Our Human Capital Management (HCM) Consulting solutions cater to every aspect of HR strategy and planning. From Recruitment, Benefits, Payrolling to Performance Management tools, we provide HCM advisory services for outlining effective HCM Strategy, vendor selection, project management, implementation & user training.
ReqRoute gives you the ability to be as smooth and quick as the technology you are dealing with by putting you in touch with our enormous database. ReqRoute has the ability to quickly respond to technology initiatives by strategically acquiring skills and economically managing accessible resources. With ReqRoute, you have access to competent, brilliant and talented professionals representing every skill set. With ReqRoute, you can bring on professionals that are truly a fit into your teams.