| Location | Durham, NC (Remote) |
100% Remote in the 28 states - North Carolina, Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming will be allowed to maintain their current residence and work remotely.
Top 3-4 Required Skills:
1. Facets tool Knowledge with deep understanding of Medical Product config, Group/member enrollment, provider network
config and claims.
2. Good understanding of Facets data Model.
3. Microsoft SQL.
4. MS Excel
Breakdown of Duties/Typical Day:
1. Facets Product Configuration
A. Document detailed Facets product configuration requirements (BCRs), including benefit codes, exceptions, provider tiering,
and benefit administration rules.
B. Develop detailed configuration design documents that translate business requirements into Facets system setup
specifications.
C. Create and maintain requirements-to-test traceability to ensure all requirements are fully validated through testing.
2. Facets Workflow Configuration
A. Partner with Claims, UM, Care Management, and Service teams to gather detailed requirements for claims routing,
exception handling, and manual review processes.
B. Develop detailed Facets workflow design documents, build configurations, and support claims and service testing activities.
What does the training look like for this role? First two weeks is understanding internal process and governance with a team member as shadowing. By week three they are working on their own with a shadow. Week 4 they should be operating solo.
Description:
System Configuration
Lead the Facets configuration and maintenance of most complex and highly critical system tables and data elements across multiple system environments
Lead the analysis, development and implementation of configuration changes to improve system performance and user efficiency
Coordinate and monitor configuration for accuracy and compliance to change control processes.
Own the end to end delivery of projects assigned to - this involves requirement documentation, design completion, Facets build delivery and test support.
Technical Support/Business Expertise
Provide significant business acumen (breadth and depth) and global technical expertise in critical systems/applications to support proactive Facets configuration solutioning for highly complex and varied business issues, while considering broader impacts of technical decisions to the current and future state business environment.
Act as domain SME for IT projects to help map their data needs to Facets configuration applications.
Act as configuration SME to triage any Facets integration solutions developed by IT partners
Lead the review, analysis and development of solutions for highly critical business systems, which may have impacts across multiple business areas or systems/applications.
Review the test scenarios, give feedback to testers; review claims test results; sometimes perform shadow testing to ensure complex configuration solution is working as we expect.
Issue Resolution
Leads work groups in assessment of business issues and facilitates the resolution of most complex or broad system/application problems by:
Coordinating initial triage for severity and business impact of system/application failures.
Leading the troubleshooting and analysis necessary to determine root cause of issues.
Coordinating the development of applicable business processes and solutions, to ensure quality, cost effectiveness, timeliness of customer service, and regulatory requirements and mandates are met.
End to end issue resolution support, like claims remediation support, impact analysis, process updates etc.