Facets Claim Adjudication Lead

Job Summary

A company is looking for a Facets Claim Adjudication Capability Lead.

Key Responsibilities:

• Oversee day-to-day operations of claim system adjudication to ensure quality and compliance
• Develop and execute complex claim system adjudication capabilities based on regulatory compliance and business requirements
• Act as a Subject Matter Expert to enhance auto-adjudication performance and drive process improvements

Required Qualifications:

• 10+ years of experience in claim processing operations, preferably in medical claims
• 5+ years of experience with the TriZetto Facets claim adjudication platform
• Experience in designing complex business operations/processes focused on scalable growth
• Vendor management experience