Lead Claims Operations Manager - FACETS

Job Description

Job Description

Pay Range: $20.00hr - $25.00hr

Job Overview:

Our client is seeking a Manager I BPM - Claims Operations (FACETS) Lead for a role in Seattle, Washington. The candidate should have 10+ years of experience in Healthcare Payer Operations, BPM Operations, and FACETS Claims Processing. This role focuses on leading end-to-end transitions, managing stakeholder relationships, and overseeing claims adjudication operations to ensure operational excellence and SLA compliance.

Key Responsibilities:

The candidate will lead the end-to-end transition and operational delivery of FACETS Claims Operations, ensuring successful knowledge acquisition, operational readiness, stabilization, and seamless transition to steady-state support.

The successful candidate will act as the primary client-facing lead and trusted advisor for Claims Operations, managing executive stakeholder relationships, governance forums, risk reviews, and operational decision-making.

The candidate will partner with SMEs and business leaders to assess current-state operations, define future-state operating models, and establish service delivery frameworks.

The candidate will drive transition planning, knowledge transfer execution, readiness assessments, and operational acceptance activities to ensure a successful handoff to delivery teams.

The candidate will oversee FACETS claims adjudication operations, ensuring adherence to productivity, quality, accuracy, turnaround time, and SLA commitments.

The candidate will establish governance processes, performance metrics, reporting dashboards, and controls to monitor operational performance and deliver continuous visibility to stakeholders.

The candidate will identify operational risks, process gaps, dependencies, and improvement opportunities, implementing mitigation plans and corrective actions to ensure delivery stability.

The candidate will collaborate with cross-functional teams including Enrollment, Provider Operations, Configuration, Application Support, and Technology teams to drive end-to-end process effectiveness.

The candidate will lead continuous improvement, automation, and transformation initiatives to enhance operational efficiency, quality, customer experience, and business outcomes.

The candidate will provide leadership, coaching, and direction to onshore and offshore operations teams, fostering a culture of accountability, collaboration, and operational excellence.

The candidate will support workforce planning, capacity management, forecasting, and resource optimization to align with client demand and business objectives.

The candidate will ensure compliance with healthcare payer regulations, policies, audit requirements, and operational governance standards.

The candidate will lead Healthcare BPM delivery and operations management, ensuring SLA adherence, productivity targets, quality performance, operational governance, and continuous process improvement.

The candidate will drive BPM transformation initiatives, process standardization, automation opportunities, operational excellence programs, and service delivery optimization across healthcare payer operations.

The candidate will manage Healthcare BPM/BPO delivery teams, stakeholder governance, performance management, and operational reviews to achieve business outcomes and customer satisfaction goals.

Required Qualifications:

• 10+ years of Healthcare Payer Operations and BPM/BPO Operations experience with deep expertise in FACETS Claims Processing and Adjudication.
• Proven experience leading large-scale transition, transformation, and managed services engagements.
• Strong understanding of Commercial, Medicare, Medicaid, and Government Programs claims operations.
• Demonstrated success managing client relationships, operational governance, service delivery, and cross-functional teams.
• Experience managing large-scale onsite/offshore BPM delivery teams.
• Strong knowledge of SLA management, productivity management, operational governance, workforce management, and continuous improvement methodologies.
• Excellent communication, stakeholder management, and leadership skills.

Preferred Qualifications:

• Experience leading Healthcare BPM transformation programs.
• Exposure to Lean Six Sigma, Process Excellence, Automation, and AI-enabled operational transformation initiatives.
• Knowledge of FACETS and Healthcare Payer operational workflows across Claims, Enrollment, Provider, Billing, and Configuration functions.

Benefits:

Our Benefits Include:

• Medical, Dental, and Vision Insurance
• 401(k) Retirement Plan
• Health Savings Account (HSA)
• Disability Insurance (Short-Term and Long-Term)
• Life and AD&D Insurance
• Paid Sick Leave (where required by applicable state or local law)
• Supplemental Insurance Plans
• Identity Theft Protection
• Pet Insurance
• Employee Wellness Programs
• Employee Assistance Program (EAP)
• Career Growth and Professional Development Opportunities

Disclaimer : Benefits eligibility, accrual rates, and usage limits may vary based on employment status, length of service, and work location. Paid Sick Leave is provided in strict accordance with applicable state and municipal mandates. Cynet Systems Inc. reserves the right to modify, amend, or terminate any benefit plans at any time in accordance with applicable laws.

About Cynet Systems

Founded in 2010 and headquartered in the Washington, DC metro area, Cynet Systems Inc. is a leading technology staffing and workforce solutions company serving Fortune 500 companies, government agencies, and enterprise organizations across the United States and Canada. We deliver agile, scalable talent solutions across IT, engineering, life sciences, clinical, and professional staffing, powered by a high-performing recruitment engine operating across North America and Asia.

As a nationally and locally certified Minority Business Enterprise (MBE), Cynet Systems is committed to helping organizations build high-performing teams while empowering professionals to grow rewarding careers. Our organization is certified to ISO 9001, ISO 14001, ISO 27001, and SOC 2 Type II standards, reflecting our commitment to quality, security, operational excellence, and customer success.