FACETS Claims Configuration Analyst

FACETS Claims Configuration Analyst,

Remote

12 months

Module / focus area: Claims

Role summary

Configure, test, and support the FACETS Claims Processing module so healthcare payer clients get accurate adjudication, pricing, and claims workflows.

Key responsibilities

• Configure claims processing rules, pricing methodologies, and adjudication logic within FACETS
• Analyze and resolve claims errors, pends, and exceptions
• Collaborate with business analysts to translate requirements into FACETS configuration
• Support UAT and production claims testing cycles
• Maintain claims-related reference tables and codes (CPT, HCPCS, ICD-10, revenue codes)

Required qualifications

• 3+ years of hands-on FACETS Claims module configuration experience; workflow experience is a must
• Strong understanding of the claims adjudication lifecycle (837/835, EOB/EOP)
• Familiarity with CPT, HCPCS, ICD-10, and revenue codes
• SQL proficiency for claims data analysis
• Healthcare payer domain knowledge (Medicare, Medicaid, or Commercial)

Preferred qualifications

• Experience with FACETS batch cycles and claims auto-adjudication tuning
• Exposure to Xcelys or QNXT (competitor platforms) for comparative context
• Agile/Scrum project experience
• FACETS certification