100% Remote Facets Configuration Subject Matter Expert (SME)
About The Position
The Facets Configuration Subject Matter Expert designs, configures, and maintains core Facets benefit, product, and pricing configurations supporting Commercial, Medicare, and Medicaid lines of business. The role partners with business, clinical, and IT teams to translate operational and regulatory requirements into accurate, scalable configurations while supporting compliance, performance, and downstream system integrity. It is hands-on and detail-oriented, and supports implementations, migrations, and ongoing operations. The position involves configuring Facets products, benefits, plans, provider contracts, pricing rules, and related structures; validating requirements and claims outcomes; troubleshooting configuration-related issues; supporting implementations, upgrades, migrations, launches, and stabilization; and maintaining documentation and configuration governance. The role also supports compliance with CMS, state Medicaid, and commercial regulatory requirements. The posting describes the role as 100% remote and a 12+ month project.
Requirements
- Deep hands-on experience configuring TriZetto Facets.
- Strong understanding of healthcare benefits, claims adjudication, and pricing logic.
- Experience configuring accumulators, benefit tiers, and complex cost-share structures.
- Ability to analyze claims results and trace configuration impacts.
- Experience supporting at least one of the following domains: Commercial, Medicare Advantage, Medicaid, or Marketplace/ACA.
- Understanding of CMS and state Medicaid regulations as they relate to configuration.
- Strong analytical and problem-solving skills.
- Ability to read and interpret Facets tables, configuration screens, and output.
- Strong communication skills with technical and non-technical stakeholders.
- Comfort working in fast-paced, ambiguous environments.
- Detail-oriented, with ownership and accountability.
- Ability to independently drive work while collaborating across teams.
Nice To Haves
- Facets implementation or upgrade project experience.
- Experience working in a consulting or managed services environment.
- Familiarity with related TriZetto modules such as NetworX, TMS, or Encounter Management.
- Experience supporting benefit changes during annual product or rate cycles.
Responsibilities
- Configure Facets products, benefits, plans, riders, accumulators, co-pays, coinsurance, deductibles, and limits.
- Build and maintain benefit matrices, contract structures, and product hierarchies.
- Configure provider contracts, reimbursement logic, fee schedules, and pricing rules.
- Support configuration for Commercial, Medicare Advantage, Medicaid, and Marketplace products.
- Translate business, regulatory, and operational requirements into Facets configuration specifications.
- Partner with business analysts, clinical teams, and operations to validate benefit intent and edge cases.
- Identify configuration gaps, limitations, or risks and recommend solutions.
- Support unit testing, integration testing, and UAT for configured components.
- Analyze claims outcomes to validate benefit and pricing accuracy.
- Troubleshoot configuration-related claim, eligibility, and enrollment issues.
- Support Facets implementations, upgrades, migrations, and product launches.
- Assist with legacy system migrations and crosswalks into Facets.
- Provide go-live and post-go-live stabilization support.
- Create and maintain configuration documentation and design artifacts.
- Support change management, versioning, and configuration governance processes.
- Ensure compliance with CMS, state Medicaid, and commercial regulatory requirements.
- Work with downstream systems such as EDW, reporting, care management, and finance.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
