100% Remote Facets Configuration Subject Matter Expert (SME)

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Please find the job description given below and let me know your interest.

Position: 100% Remote Facets Configuration Subject Matter Expert (SME)
Location: Remote

Duration: 12+month project

Quick Interview

Job Description

The Facets Configuration SME is responsible for designing, configuring and maintaining core Facets benefit, product and pricing configurations to support Commercial, Medicare and Medicaid lines of business. This role partners closely with business, clinical and IT teams to translate operational and

regulatory requirements into accurate, scalable Facets configurations while ensuring compliance, performance and downstream system integrity.

This role is hands-on, detail-oriented and critical to successful implementations, migrations and ongoing operations.

Key Responsibilities Facets Configuration and Design

• 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

Requirements Translation

• 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 early and recommend solutions

Testing and Validation

• 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

Implementation and Migration Support

• 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

Governance and Documentation

• 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

Required Skills and Experience Core Skills

• 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

Domain Experience

• Experience supporting one or more of:
• Commercial
• Medicare Advantage
• Medicaid
• Marketplace / ACA
• Understanding of CMS and state Medicaid regulations as they relate to configuration

Technical and Analytical Skills

• Strong analytical and problem-solving skills
• Ability to read and interpret Facets tables, configuration screens and output
• Experience working with downstream systems (EDW, reporting, care management, finance)

Preferred Qualifications

• Facets implementation or upgrade project experience
• Experience working in a consulting or managed services environment
• Familiarity with related TriZetto modules (NetworX, TMS, Encounter Management)
• Experience supporting benefit changes during annual product or rate cycles

Soft Skills

• Strong communication skills with both technical and non-technical stakeholders
• Comfortable working in fast-paced, ambiguous environments
• Detail-oriented with a strong sense of ownership and accountability
• Able to independently drive work while collaborating across teams

Thanks & Regards,
Gaurav Gaur
Email: | Phone :

LinkedIn:

DMS Vision ,INC

4645 Avon Lane, Suite 210

Frisco, TX 75033