Facets Product/Benefit SME

Title:  Facets Product/Benefit SME
Location: 100% remote
Duration: 12 months
Interview: MS Teams

Job Description:

Serve as the go-to domain expert on plan/benefit design and build for a health plan/payer organization, guiding FACETS configuration decisions, business process design, and cross-functional initiatives from a product lens.

• Act as the primary subject matter authority on benefit lifecycle: plan design, components/variable components/LOB, Best practices, maintenance
• Advise configuration and IT teams on how products build or configured and promoted translated into FACETS.
• Review and validate product configuration with plan design documents for accuracy across systems (FACETS, eligibility, UM,CS,  management tools and external platforms
• Support product strategy, discussions.
• Lead root-cause analysis on product related claims adjudication discrepancies, escalations, and disputes
• 6+ years of experience in product build and design
• Deep understanding of plan/benefits/constructions.
• Strong knowledge of enrolment process, claim processes and other product surround technologies
• Experience working with FACETS or similar core administration platforms (QNXT, Xcelys) from a business/functional standpoint
• Ability to translate benefit language into system/business rule requirements
• Strong analytical skills - comfortable digging into claims/provider data to identify root causes
• Experience collaborating with IT/configuration teams to bridge business and technical requirements
• Six Sigma/process improvement certification
• Experience in multi-state or multi-line-of-business payer environments (Medicare Advantage, Medicaid, Commercial, ACA)