Facets Configuration SME

Facets Configuration Subject Matter Expert (SME) with deep expertise across core Facets modules. This SME will support complex configuration initiatives across claims, provider/payment arrangements, benefit structures, and financial responsibility allocations. The role plays a critical part in ensuring accurate adjudication, operational efficiency, and compliance across payer, IPA, and delegated models.

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Key Responsibilities:

• Lead end-to-end Facets configuration , including Benefits, Provider, Claims, Pricing, and Workflow components, ensuring accurate system behavior and alignment with business rules.
• Interpret and translate contract terms, plan documents, and organizational payment models into system-ready configuration specifications.
• Collaborate closely with internal business teams—Claims, Finance, Provider Contracting, Delegation Oversight, Enrollment, and IT—to ensure configuration accuracy, alignment, and traceability.
• Perform configuration testing: UAT, regression, scenario-based adjudication, and impact analysis.
• Support downstream and upstream integrations, including pricing engines, delegated entity data exchanges, and reporting datasets.
• Maintain configuration documentation, version control, job aids, and process playbooks.
• Serve as a senior advisor, offering guidance on Facets best practices, configuration strategy, and optimization.

Required Qualifications:

• 5+ years of hands-on Facets configuration experience across multiple subsystems (e.g., Benefits, Provider, Workflow, Claims).
• Strong understanding of claims adjudication, benefit interpretation, reimbursement methodologies, and provider contract logic.
• Experience working in payer, IPA, MSO, or delegated-risk environments
• Demonstrated experience supporting system upgrades, release cycles, or new implementation initiatives.
• Strong analytical, problem-solving, and documentation skills. xhyhwjd
• Excellent communication skills, with the ability to collaborate across technical and nontechnical stakeholders.