Design and document comprehensive Desk Level Procedures (DLPs) across claims, benefits, enrollment, and configuration workflows
Translate business processes and system functionality into clearly defined, step-by-step operational procedures for end users
Develop DLPs that outline:
Standard workflows
Exception handling processes
Step-by-step issue resolution procedures
Ensure documentation is accurate, complete, and aligned with current Facets system behavior and business rules
Partner with configuration teams to align DLPs with Facets system setup across membership, billing, claims, benefits, provider, and pricing modules
Translate configuration logic into operational procedures for claims processing, adjustments, and issue resolution
Support troubleshooting of claims and benefit-related issues tied to configuration gaps or system logic
Validate that operational processes reflect accurate claims adjudication workflows and system dependencies
Provide deep subject matter expertise in:
Membership including premium billing
Claims adjudication workflows
Benefits configuration and plan design
Provider payment and reimbursement processes
Develop procedures that help teams:
Investigate errors
Identify configuration issues
Execute corrections and reprocessing steps
Ensure procedures support consistent, compliant claims and benefits operations
Create DLPs that clearly outline:
How to identify root causes of claims or configuration issues
Step-by-step actions to resolve issues within Facets or downstream systems
Escalation paths and cross-team dependencies
Partner with operational and IT teams to analyze recurring issues and improve existing procedures
Drive consistency in how teams diagnose and resolve claims, configuration, and workflow issues
Collaborate with Claims, Enrollment, Provider Configuration, IT, and Operations teams to define and validate processes
Translate complex technical and system concepts into clear, business-friendly documentation
Support training initiatives by providing DLP documentation and operational guidance for end users
Continuously evaluate and enhance DLPs to improve:
Operational efficiency
Accuracy and consistency
Issue resolution timelines
Standardized procedures across clients and environments to ensure repeatable, scalable delivery models
Support system implementations, conversions, and operational transformations with DLP development
Requirements
5+ years of experience working within Healthcare Payer operations
5+ years of healthcare payer experience (Medicare and Medicaid)
5+ years of hands-on experience with Facets (TriZetto), particularly in:
Premium billing
Claims processing
Benefits/Provider configuration
Operational workflows
Deep understanding of:
Eligibility and premium billing
Claims adjudication processes
Benefits configuration and plan structures
Proven ability to:
Translate complex processes into clear, step-by-step instructions
Troubleshoot and resolve system/process-related issues
Experience working in a consulting or client-facing environment
Benefits
medical, dental, and vision coverage to employees and dependents
a 401(k) plan with a generous employer match
an employee stock purchase plan
a generous Paid Time Off policy
paid parental leave and adoption assistance
Our Wellness Program supports employee total well-being by providing free annual health screenings and coaching, bank at work, and on-site workshops, as well as ongoing programs recognizing major events in the lives of our employees throughout the year