Healthcare Claims & Benefits Configuration Analyst (Facets)

Mason, OH - USA

Monthly Salary: Not Disclosed

Posted on: 30+ days ago

Vacancies: 1 Vacancy

Job Summary

Healthcare Claims & Benefits Configuration Analyst (Facets)

Location: 4000 Luxottica Place Mason OH 45040 (Hybrid 2 days per week onsite)
Duration: 3 Months with possible extension
Work Hours: 8 AM to 5 PM EST (1-hour break; 40 hours/week)

Pay Rate: $50-55/hr. W2 All Inclusive

Role Overview

Serve as a Sr. Configuration Analyst on the Business Configuration Solutions team. Responsible for the enablement of member benefit configuration strategies by designing implementing and executing configuration. Lead projects for the Configuration space to enable system and process solutions for Business Configuration tool sets.

Key Responsibilities

Serve as a subject matter expert for the Business Configuration team supporting EyeMeds cross-functional teams to implement client requirements.
Lead/represent cross-functional meetings and capture business requirements.
Serve as a subject matter expert representing the Configuration workstream for large Government Implementations for Medicaid Med/Surgical and Medicare programs.
Provide data analysis and troubleshooting expertise on configuration tool sets with automated processes.
Prepare data for analysis by removing duplicates errors and outliers; perform data validation.
Build SQL queries to pull backend data based on configuration needs.
Serve as a Business Analyst documenting requirements process flows and executing testing for enhancements to improve the automation toolset.
Perform Fit/Gap Analysis and feedback assessments for new client plans.
Collaborate with leadership on configuration roadmap deliverables and automation of EyeMeds product and network offerings.
Self-manage and prioritize to meet SLAs and KPIs.
Build and maintain strong stakeholder relationships across EyeMed.

Must-Have Qualifications

Facets experience
SQL/Database expertise
Healthcare claims understanding and benefit configuration
Analytical & problem-solving capability
Experience with Oracle SQL for data validation and Facets for claims testing
Experience in Medicaid product configuration
Windows OS proficiency
Exposure to Informatica-based automation tools (EyeMed homegrown tool)

Preferred Qualifications

5 years experience with Facets platform
Experience with Medical Plan Benefit Configuration
Provider Network & Agreement Configuration
Knowledge of Medicare/Medicaid
Excellent communication and interpersonal skills
Fast learner with strong analytical skills

Education

Bachelors degree or equivalent work experience

CANDIDATE SELF-ASSESSMENT: SKILL QUALIFICATION MATRIX

Please fill out the below matrix while applying. Use a scale of 1 (Beginner) to 10 (Expert) for the Self-Rating column.

Skill Category	Required or Preferred	Self-Rating (1-10)	Years of Experience	Notes / Comments
Facets Platform	Required
Healthcare Claims Knowledge	Required
Benefit Configuration	Required
SQL / Database	Required
Oracle SQL	Required
Medicaid Product Configuration	Required
Data Analysis & Troubleshooting	Required
Cross-Functional Leadership	Required
Process Documentation	Required
Testing & Validation	Required
Informatica / Automation Tools	Required
Medicare Knowledge	Preferred
Medical Plan Configuration	Preferred
Provider Network Configuration	Preferred
Communication & Interpersonal Skills	Preferred
Self-Prioritization / SLA Delivery	Preferred

Healthcare Claims & Benefits Configuration Analyst (Facets) Location: 4000 Luxottica Place Mason OH 45040 (Hybrid 2 days per week onsite) Duration: 3 Months with possible extension Work Hours: 8 AM to 5 PM EST (1-hour break; 40 hours/week) Pay Rate: $50-55/hr. W2 All Inclusive Role Overvie...