Title: FACETS Solution Architect
Terms of Employment
W2 Contract-to-Hire, 6 Months
Remote Opportunity (Need to come onsite occasionally)
Candidate should reside in client-preferred states.
Overview:
Work with a leading healthcare payer enterprise as a Principal Solution Architect on a high-priority Core Consolidation initiative. In this role, you will be responsible for streamlining complex data flows, redesigning batch sequencing, and optimizing integrations between the Facets platform and external claims editing vendors to drastically improve claims adjudication performance and support key provider SLAs.
Key Responsibilities:
Architect, redesign, and streamline end-to-end batch processing and claims data flows within the Facets platform.
Define optimal integration patterns and frameworks to connect Facets with surrounding enterprise systems and third-party claims editing tools.
Optimize batch sequencing and shell-out calls to external claims editing platforms (such as ClaimsXten or HCFS PreShield) to reduce latency and speed up adjudication.
Evaluate and refactor data staging and storage points across the end-to-end claims lifecycle to eliminate processing inefficiencies.
Collaborate with enterprise architecture and engineering teams to perform both high-level solution architecture and low-level technical design using out-of-the-box Facets modules and custom extensions.
Guide architectural deployments within an Azure cloud environment.
Required Qualifications:
Minimum 8 10 years of experience in the Healthcare Payer industry with a primary focus on claims processing and adjudication workflows.
Extensive solution architecture experience with Facets G6 (or 5+ years of deep Facets Legacy experience with strong business process and data flow expertise).
Strong technical background with experience in low-level design, Facets out-of-the-box modules, and Facets custom development/engineering within the last two years.
Proven track record with Facets Integration Frameworks and designing complex system integration patterns.
Experience with claims editing tools and vendor batch integration sequences (e.g., ClaimsXten, HCFS PreShield, or similar).
Experience working with cloud-based deployments, specifically within Microsoft Azure.
Must have experience working with claims processing, enrollment, billing & payments, underwriting, partner programs, business operations, and benefit management business functions either in a commercial or government area (both preferred).
Preferred Qualifications:
A balanced background covering both Commercial and Government Programs (Medicare/Medicaid) lines of business.
Experience with Edifecs integration tools.
Experience with VMS/Provider Network Management platforms such as Versys12.
Familiarity with HealthEdge or GuidingCare platforms
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