Website:
dutech.ai
Job details:
- Job Title: Facets SME (Subject Matter Expert)
- Location: USA 1 position and India 4 positions
- Employment Type: Full-time
- Industry: US Healthcare
- Role Overview
- We are seeking a highly experienced Facets SME with deep expertise in the TriZetto Facets platform to drive configuration, implementation, optimization, and support of core payer operations. This role will act as a functional and technical bridge between business stakeholders, IT teams, and third-party vendors, ensuring scalable and compliant healthcare solutions.
- Key Responsibilities
- 1. Facets System Expertise
- ● Act as the primary SME for Facets modules including: ○ Membership & Enrollment ○ Claims Processing ○ Provider Management ○ Billing & Capitation
- ● Lead system configuration, enhancements, and troubleshooting
- ● Ensure optimal system performance and data integrity
2. Business & Functional Leadership
● Translate complex business requirements into Facets configurations and workflows
● Collaborate with stakeholders across operations, compliance, and IT
● Drive process standardization and optimization across payer workflows
3. Implementation & Integration
● Lead or support Facets implementation / migration projects
● Work on integrations with: ○ EDI systems (834, 837, 835, 270/271) ○ Third-party vendors ○ Data warehouses and analytics platforms
● Ensure seamless interoperability across systems
4. Claims & Enrollment Expertise
● Deep understanding of: ○ Claims lifecycle (adjudication, pricing, payment) ○ Enrollment workflows and eligibility rules
● Troubleshoot production issues and ensure SLA adherence
5. Compliance & Governance
● Ensure compliance with: ○ HIPAA regulations ○ CMS guidelines ○ Internal audit and governance policies ● Support audit readiness and regulatory reporting
6. Stakeholder Management
● Act as a trusted advisor to business leaders
● Conduct workshops, training sessions, and knowledge transfer
● Provide strategic recommendations for system improvements
Required Qualifications
● Bachelor’s degree in Engineering, Healthcare, IT, or related field
● 5–12+ years of experience in US Healthcare Payer systems
● Strong hands-on experience with TriZetto Facets
● Expertise in claims processing and enrollment modules
● Experience with EDI transactions (834, 837, 835, etc.)
● Strong understanding of healthcare regulations (HIPAA, CMS)
Preferred Qualifications
● Experience in Facets upgrades / implementations
● Knowledge of SQL, data analysis, and reporting tools
● Exposure to cloud platforms (AWS/Azure)
● Certifications in Facets or healthcare domain
Key Skills
● Facets Configuration & Optimization
● US Healthcare Payer Domain Expertise
● Claims Adjudication & Enrollment
● EDI & System Integration
● Problem Solving & Root Cause Analysis
● Stakeholder Communication
● Process Improvement & Automation Success Metrics (KPIs)
● Reduction in claims processing errors
● Improved system performance & uptime
● Faster turnaround time for issue resolution
● Successful implementation of enhancements
● Compliance audit success rate
Why Join Us?
● Work on large-scale US healthcare transformation programs
● Opportunity to influence core payer systems and strategy
● Collaborative, high-impact role with leadership visibility
● Continuous learning and growth in healthcare technology
Bonus: Ideal Candidate Profile
● Combines functional + technical expertise
● Strong problem-solver with production support experience
● Experience in multi-payer or large enterprise environments
● Ability to work in fast-paced, global delivery models
Click on Apply to know more.