BPM - Claims Operations (FACETS) Lead

Job Description

Job Summary

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We are seeking an experienced BPM Claims Operations Lead with strong Healthcare Payer, FACETS Claims Processing, and BPM/BPO expertise to lead operational transitions, service delivery, client governance, and continuous improvement initiatives.

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Mandatory areas – Claims Operations - 10+ years

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Must Have skills:

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- FACETS

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- Healthcare Systems

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- Claims Management

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- Stakeholder Management

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Key Responsibilities

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• Lead end-to-end transition, knowledge transfer, operational readiness, and stabilization of FACETS Claims Operations.
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• Manage client relationships, stakeholder governance, operational reviews, and risk mitigation.
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• Oversee claims adjudication operations, ensuring SLA compliance, quality, accuracy, productivity, and turnaround times.
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• Drive process optimization, automation, standardization, and BPM transformation initiatives.
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• Manage onshore/offshore teams, workforce planning, capacity management, and resource optimization.
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• Establish performance metrics, reporting dashboards, and operational governance frameworks.
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• Collaborate with Enrollment, Provider, Billing, Configuration, and Technology teams.
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• Ensure compliance with healthcare regulations, client policies, and audit requirements.
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Required Qualifications

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• 10+ years of Healthcare Payer Operations and BPM/BPO experience.
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• Strong expertise in FACETS Claims Processing and Adjudication.
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• Experience leading large-scale transitions, transformations, and managed services engagements.
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• Knowledge of Commercial, Medicare, Medicaid, and Government Programs claims operations.
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• Proven experience in client management, SLA governance, workforce planning, and operational delivery.
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• Experience managing large onshore/offshore teams.
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• Strong leadership, communication, stakeholder management, and problem-solving skills.
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Preferred Qualifications

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• Experience leading Healthcare BPM transformation programs.
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• Knowledge of Lean Six Sigma, process excellence, automation, and AI-enabled transformation.
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• Exposure to FACETS workflows across Claims, Enrollment, Provider, Billing, and Configuration.
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Key Success Metrics

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• SLA and KPI compliance
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• Claims processing quality and accuracy
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• Productivity and turnaround time
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• Successful transition and operational stabilization
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• Continuous improvement and customer satisfaction
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