Domain Consultant L2(Contract)
About The Position
The role analyzes client business processes and evaluates process-improvement opportunities through market and benchmarking studies. In this position, the consultant works on Medicaid regulatory solutions, translating regional and state requirements into technical changes across TriZetto Facets and related applications. The role designs, develops, configures, and maintains solutions for membership, eligibility, benefits, claims, provider-related processing, and Medicaid-specific rules. It also develops Java and Mainframe components and builds data integration solutions, while supporting testing, production implementation, troubleshooting, and technical documentation.
Requirements
- 5–8 years of experience.
- Strong hands-on experience with TriZetto Facets.
- Strong Java/J2EE engineering and programming skills.
- Experience with IBM DataStage and Talend/TalendWorks or comparable enterprise ETL technologies.
- Strong understanding of Medicaid managed-care operations and state-specific regulatory requirements.
- Experience implementing regulatory or business-rule changes within healthcare payer platforms.
- Strong Facets experience in membership, eligibility, benefits, claims, claims adjudication, and pricing/payment processing.
- Good understanding of Medicaid and Medicare health-plan processes.
- Experience with SQL, databases, batch processing, APIs/interfaces, and data integration.
- Strong debugging, production support, and root-cause-analysis skills.
- Mandatory skill: HC - Payor.
Responsibilities
- Analyze regional and state Medicaid regulatory requirements and translate them into technical changes across Facets and surrounding applications.
- Design, develop, configure, and maintain solutions for member enrollment and eligibility, membership maintenance, benefits and plan configuration, claims intake and adjudication, claims pricing and payment, provider-related claim processing, Medicaid-specific edits and business rules, and Medicare/Medicaid coordination where applicable.
- Develop and enhance Java-based applications, APIs, interfaces, batch programs, and integration components supporting Facets.
- Develop or modify Mainframe programs and batch-processing components supporting Medicaid processes.
- Perform Facets configuration and development for regulatory and business-rule changes.
- Build and maintain ETL and data integration solutions using IBM DataStage and Talend/TalendWorks.
- Analyze upstream and downstream impacts of regulatory changes across Facets, data platforms, interfaces, and surrounding applications.
- Conduct code reviews, unit testing, defect resolution, root-cause analysis, and technical quality assessments.
- Support system integration testing, regression testing, and production implementation.
- Troubleshoot complex claims, membership, eligibility, and regulatory processing issues.
- Develop reusable engineering approaches for common regulatory requirements while accommodating state-specific variations.
- Maintain technical specifications, mappings, configuration documentation, traceability, and implementation artifacts.
- Analyze client business processes and conduct market and benchmarking studies to evaluate process-improvement opportunities and propose enhancements.
Benefits
- Medical and dental benefits options
- Disability insurance
- Paid time off, inclusive of sick leave
- Other paid and unpaid leave options
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What This Job Offers
Career Level
Mid Level
Education Level
No Education Listed
