Facets Config Support (Clinical)

Job Summary:

We are seeking an experienced TriZetto Facets Configuration Consultant with expertise across Clinical Configuration, Benefits Configuration, and Provider Data Management. The ideal candidate will have hands-on experience configuring the Facets platform, supporting benefit plan implementation, managing provider data, and providing strategic guidance to business and technical teams. This role involves collaborating with cross-functional stakeholders to configure, troubleshoot, and optimize healthcare payer solutions while ensuring accurate downstream data flow and compliance with business requirements.

Key Responsibilities

• Configure and maintain TriZetto Facets modules, including Clinical, Benefits, and Provider Data.
• Design, configure, and support clinical workflows, authorization rules, and utilization management processes.
• Configure benefit plans, Service IDs, product structures, and mapping definitions.
• Manage provider data setup, maintenance, credentialing support, and provider network configuration.
• Perform issue triage, root cause analysis, and production support for Facets-related incidents.
• Ensure accurate provider and benefit data flow across downstream applications and integrated systems.
• Gather, analyze, and translate business requirements into scalable Facets configuration solutions.
• Collaborate with business analysts, developers, QA teams, and business stakeholders throughout the project lifecycle.
• Develop and execute test cases, support System Integration Testing (SIT) and User Acceptance Testing (UAT).
• Document configuration changes, business rules, technical specifications, and operational procedures.
• Support system upgrades, releases, migrations, and enhancement initiatives.
• Monitor system performance and recommend process improvements and best practices.
• Provide strategic input for solution design, configuration optimization, and healthcare payer operations.

Required Qualifications

• Bachelor''s degree in Computer Science, Information Technology, Healthcare Administration, or a related field.
• 5+ years of hands-on experience with TriZetto Facets Configuration.
• Strong experience with Clinical, Benefits, and Provider Data modules.
• Experience configuring Service IDs, benefit plans, products, and mapping definitions.
• Knowledge of provider enrollment, maintenance, provider contracts, and network management.
• Experience with healthcare payer operations, including Claims, Membership, Benefits, Eligibility, and Provider Management.
• Strong troubleshooting and production support experience.
• Experience working with SQL for data validation and analysis.
• Familiarity with system integrations, APIs, and downstream data flow.
• Experience working in Agile/Scrum environments.
• Excellent analytical, communication, and documentation skills.

Preferred Qualifications

• Experience with TriZetto implementation or migration projects.
• Knowledge of EDI transactions (834, 835, 837, 270/271).
• Experience with healthcare regulations such as HIPAA.
• Exposure to Facets upgrades and cloud-based healthcare platforms.
• Certification in TriZetto Facets or related healthcare technologies is a plus.

Technical Skills

• TriZetto Facets Configuration
• Clinical Configuration
• Benefits Configuration
• Provider Data Management
• Service ID Configuration
• Benefit Mapping
• Claims Processing
• Membership & Eligibility
• Provider Maintenance
• SQL
• XML
• EDI (834, 835, 837, 270/271)
• Data Mapping
• System Integration
• Production Support
• UAT/SIT Testing
• Jira
• Agile/Scrum

Healthcare Domain

• Healthcare Payer
• Health Insurance
• Managed Care
• Commercial Plans
• Medicare
• Medicaid

This combined role is ideal for a TriZetto Facets SME who can support Clinical Configuration, Benefits Configuration, and Provider Data Management while providing both hands-on configuration and strategic guidance for healthcare payer implementations and support.