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Only W2- Facets Claims Adjustment Specialist

Digitive LLC

Remote • Today

Easy Apply

Third Party, Contract

Depends on Experience

Only W2- Facets Workflow

Digitive LLC

Remote • Today

Easy Apply

Third Party, Contract

Depends on Experience

Facets Developer

SysMind, LLC

Durham, North Carolina • 15d ago

Easy Apply

Third Party, Contract

$48 - $52

FACETS Consultant

Career Soft Solutions Inc

Durham, North Carolina • Yesterday

Easy Apply

Third Party, Contract

$60+

Facets Technical Consultant

Lorven Technologies, Inc.

Remote • 2d ago

Easy Apply

Third Party, Contract

$55 - $60

Claims Adjuster (W2)

Voto Consulting LLC

Hybrid in Phoenix, Arizona • 2d ago

Easy Apply

Contract

$37

Sr Claims Systems Analyst - AI-Enabled

Curative

Remote or Austin, Texas • Today

Full-time

USD 110,000.00 - 165,000.00 per year

Workers Compensation Claims Adjuster

Apidel Technologies

Remote • Today

Easy Apply

Contract

52 - 56

Auto Claims Adjuster

Prism IT Global

Phoenix, Arizona • 7d ago

Easy Apply

Contract

$$35/hr - $40/hr on W2

Claims Adjuster - Workers Compensation - Remote / Telecommute

Cynet Systems

Pasadena, California • Today

Easy Apply

Contract, Third Party

Depends on Experience

Senior EDI Support Specialist / EDI / Healthcare Payer | Facets Ecosystem

UNICOM TECHNOLOGIES INC

Remote • Today

Easy Apply

Full-time, Part-time, Contract, Third Party

USD 55-60

FACETS Developer

Cardinal Integrated Technologies Inc

Hybrid in Seattle, Washington • 30+d ago

Easy Apply

Third Party, Contract

Depends on Experience

Senior Technical Claims Specialist, Environmental

Liberty Mutual Insurance

Dover, New Hampshire • Today

Full-time

Compensation information provided in the description

Senior Technical Claims Specialist, Environmental

Liberty Mutual Insurance

Lake Oswego, Oregon • Today

Full-time

Compensation information provided in the description

Senior Technical Claims Specialist II, Environmental Claims

Liberty Mutual Insurance

Lake Oswego, Oregon • Today

Full-time

Compensation information provided in the description

Claims Adjuster

Apex Systems

Birmingham, Alabama • Today

Easy Apply

Full-time

$52,000 - $106,000

Facets-Technical Consultant-with Healthcare Exp

Tektree Systems Inc.

Remote • Today

Easy Apply

Contract

Depends on Experience

FACETS Developer

Spar Information Systems

Seattle, Washington • Today

Easy Apply

Contract, Third Party

Microsoft Teams Migration Specialist - Only W2

Info Dinamica Inc

Remote or Arkansas • Today

Easy Apply

Contract

Mechanical Claims Adjuster

Kforce Technology Staffing

Jacksonville, Florida • Today

Full-time

$41,480 - $56,120 annually

Job Details

Skills

Facets
Claims Processing

Summary

Job Title: Mass Claims Adjustment Execution/Facets Claims Adjustment Specialist

Location: Remote

Key Responsibilities

Mass Claims Adjustment Execution

Review and validate incoming requests for mass claim adjustments (typically 50+ affected claims), ensuring completeness, accuracy, and alignment with internal guidelines.
Treat each adjustment request as a mini project, managing intake, validation, execution steps, and closure.
Create and manage templates for adjustments within the Facets UI, including benefit, pricing, and configuration touchpoints as needed.
Process adjustments through Azure DevOps, ensuring traceability, documentation, and timely updates.
Perform root cause validation and reconcile claim subsets to verify that the adjustment request aligns with actual claim conditions.

Claims Subject Matter Expertise

Apply advanced knowledge of Facets claims processing, including benefit applications, pricing tables, accumulators, provider configuration, and backend system behavior.
Execute claim adjustments manually and systemically with a deep understanding of how downstream systems and configuration impact results.
Identify potential configuration issues, trends, and systemic defects that contribute to mass adjustment demand.

Data Analysis & Validation

Analyze large data sets to identify impacted claims, validate request criteria, and ensure accuracy before and after adjustment execution.
Utilize data tools to confirm that the adjustment logic matches expected claim scenarios and business requirements.
Produce clear, logically structured summaries outlining root causes, validation results, and historical trends to reduce repetitive requests.

Stakeholder Communication & Collaboration

Communicate effectively with requesters, markets, operations teams, and leadership to obtain approvals, clarify requirements, and provide post adjustment summaries.
Explain complex claims scenarios, configuration logic, and adjustment rationales in a clear, business friendly way.
Partner closely with automation teams to identify process improvement and automation opportunities, reducing manual ticket submissions.

Operational Governance & Quality Control

Ensure all adjustments follow internal standards, quality expectations, and compliance requirements.
Participate in trend analysis discussions and continuous process improvement initiatives across claims operations.
Support documentation updates, workflow refinements, and knowledge transfer within the MCA team.

Required Skills & Qualifications

Technical & Functional Expertise

Must have: Advanced Facets claims processing experience, including claim lifecycle, pricing rules, benefit application logic, and backend workflows.
Strong understanding of claim adjustment processes and downstream operational impacts.
Experience validating high volume claim scenarios and interpreting adjustment logic.
Familiarity with configuration concepts such as:
- Benefit plan structures
- Pricing/reimbursement tables
- Provider and member configuration
- Edit logic and adjudication rules

Data & Analytical Skills

Ability to analyze large claims datasets using Excel or similar tools.
Skilled in validating subsets of claims against request criteria and identifying discrepancies.
Ability to summarize root causes and trends using data driven analysis.

Communication & Collaboration

Strong written and verbal communication skills, able to translate technical claims logic into clear business explanations.
Experience partnering with operations teams, requesters, markets, or other business units.
Ability to manage multiple adjustment initiatives simultaneously with attention to detail and accuracy.

Tools & Systems

Facets (required) – deep operational expertise.
Azure DevOps (preferred) – for request tracking and workflow management.
Microsoft Excel and data validation tools (required).

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 91159525
Position Id: 9843-5611-1793809507
Posted 8 hours ago

Fitment

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Similar Jobs

Only W2- Facets Workflow

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Facets Workflow Location: Remote Must Haves Facets Configuration Benefits, Claims, UM experience Workflow functionality experience Lead and Facilitate Client Meetings Job Summary As a Facets Workflow consultant, you will play a pivotal role in driving product excellence within our organization. With a focus on Facets - Plan Product, Membership, and Group, you will leverage your extensive experience to enhance product offerings and ensure alignment with business objectives. Your contributi

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Position: Lead Facets Consultant Location: Remote Duration: 6 12 Months Job Description: Must Have's Facets Configuration Benefits, Claims, UM experience Workflow functionality experience Lead and Facilitate Client Meetings Facets Workflow: Job Summary As a Lead Product Consultant, you will play a pivotal role in driving product excellence within our organization. With a focus on Facets - Plan Product, Membership, and Group, you will leverage your extensive experience to enhance p

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Facets Technical Consultant

Remote

•

2d ago

Role: Facets - Technical Consultant Location: Remote CST Contract Role Job description: Must Have's: 1. Facets - Claims, Eligibility 2. Java, Oracle, SQL, Kubernetes 3. WTX, EDI, PostgreSQL Design, develop, test, and support Java-based solutions across Claims, Eligibility, and other regulatory work, with complementary platform, data, and integration experience aligned to confirmed demand. Facets knowledge is required, along with healthcare experience supporting member eligib

Easy Apply

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Facets Workflow SME

Remote

•

Today

Amtex SystemsInc is an information technology and talent solutions company offering talent and BI consulting to the companies in US for over 25 years. Our solutions are designed to fill resource gaps, by providing the right candidates who deliver value to the organization. Our propensity to nurture and build strong relationships with our clients helps us better understand their business demands and gives us the ability to provide services that are on time and rise above the rest. Facets Workflow

Easy Apply

Contract, Third Party

Depends on Experience

Job Details

Skills

Facets
Claims Processing

Summary

Job Title: Mass Claims Adjustment Execution/Facets Claims Adjustment Specialist

Location: Remote

Key Responsibilities

Mass Claims Adjustment Execution

Review and validate incoming requests for mass claim adjustments (typically 50+ affected claims), ensuring completeness, accuracy, and alignment with internal guidelines.
Treat each adjustment request as a mini project, managing intake, validation, execution steps, and closure.
Create and manage templates for adjustments within the Facets UI, including benefit, pricing, and configuration touchpoints as needed.
Process adjustments through Azure DevOps, ensuring traceability, documentation, and timely updates.
Perform root cause validation and reconcile claim subsets to verify that the adjustment request aligns with actual claim conditions.

Claims Subject Matter Expertise

Apply advanced knowledge of Facets claims processing, including benefit applications, pricing tables, accumulators, provider configuration, and backend system behavior.
Execute claim adjustments manually and systemically with a deep understanding of how downstream systems and configuration impact results.
Identify potential configuration issues, trends, and systemic defects that contribute to mass adjustment demand.

Data Analysis & Validation

Analyze large data sets to identify impacted claims, validate request criteria, and ensure accuracy before and after adjustment execution.
Utilize data tools to confirm that the adjustment logic matches expected claim scenarios and business requirements.
Produce clear, logically structured summaries outlining root causes, validation results, and historical trends to reduce repetitive requests.

Stakeholder Communication & Collaboration

Communicate effectively with requesters, markets, operations teams, and leadership to obtain approvals, clarify requirements, and provide post adjustment summaries.
Explain complex claims scenarios, configuration logic, and adjustment rationales in a clear, business friendly way.
Partner closely with automation teams to identify process improvement and automation opportunities, reducing manual ticket submissions.

Operational Governance & Quality Control

Ensure all adjustments follow internal standards, quality expectations, and compliance requirements.
Participate in trend analysis discussions and continuous process improvement initiatives across claims operations.
Support documentation updates, workflow refinements, and knowledge transfer within the MCA team.

Required Skills & Qualifications

Technical & Functional Expertise

Must have: Advanced Facets claims processing experience, including claim lifecycle, pricing rules, benefit application logic, and backend workflows.
Strong understanding of claim adjustment processes and downstream operational impacts.
Experience validating high volume claim scenarios and interpreting adjustment logic.
Familiarity with configuration concepts such as:
- Benefit plan structures
- Pricing/reimbursement tables
- Provider and member configuration
- Edit logic and adjudication rules

Data & Analytical Skills

Ability to analyze large claims datasets using Excel or similar tools.
Skilled in validating subsets of claims against request criteria and identifying discrepancies.
Ability to summarize root causes and trends using data driven analysis.

Communication & Collaboration

Strong written and verbal communication skills, able to translate technical claims logic into clear business explanations.
Experience partnering with operations teams, requesters, markets, or other business units.
Ability to manage multiple adjustment initiatives simultaneously with attention to detail and accuracy.

Tools & Systems

Facets (required) – deep operational expertise.
Azure DevOps (preferred) – for request tracking and workflow management.
Microsoft Excel and data validation tools (required).

Dice Id: 91159525
Position Id: 9843-5611-1793809507
Posted 8 hours ago

Fitment

Dice Job Match Score™

To see how well you match this job, please log in or create an account.

Once logged in, be sure to complete your profile to get the most accurate match score.

Create job alert

Never miss an opportunity! Create an alert based on the job you applied for.

Similar Jobs

Only W2- Facets Workflow

Remote

•

Today

Easy Apply

Third Party, Contract

Depends on Experience

Lead Facets Consultant @ Remote

Remote

•

Today

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Third Party, Contract

Depends on Experience

Facets Technical Consultant

Remote

•

2d ago

Easy Apply

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$55 - $60

Facets Workflow SME

Remote

•

Today

Easy Apply

Contract, Third Party

Depends on Experience