[Hiring] Facets Technical Subject Matter Expert @DMS Vision

Role Description

The Facets Technical SME is a senior, hands-on expert responsible for the back-end, data and processing aspects of the TriZetto Facets platform. This role focuses on batch processing, data analysis, interfaces and system behavior rather than front-end configuration. The Facets Technical SME partners with configuration, operations and integration teams to diagnose issues, ensure data integrity and support stable, compliant Facets operations across multiple lines of business. This role is critical for root-cause analysis, platform stability, complex troubleshooting and large-scale Facets implementations, upgrades and migrations.

Key Responsibilities

• Facets Core Processing
  • Support and analyze eligibility, enrollment, claims and financial processing within Facets
  • Own understanding of Facets batch cycles (daily, weekly, monthly, EOM/EOY) and job dependencies
  • Diagnose and resolve processing errors, reprocessing issues and retroactivity impacts
  • Support adjustments, reversals and claim re-adjudication activities
• Data Analysis and SQL
  • Perform deep-dive data analysis using SQL against Facets databases
  • Trace claims, enrollment and financial outcomes back to source data and configuration
  • Validate processing results and identify root causes of discrepancies
  • Support data reconciliation across Facets and downstream systems
• Interfaces and Integrations
  • Support inbound and outbound Facets interfaces, including:
    • Enrollment (834)
    • Claims (837)
    • Encounters
    • Provider data
    • Extracts to EDW, finance, care management and reporting platforms
  • Analyze interface errors, file rejects and data mapping issues
  • Partner with integration teams to resolve defects and improve interface stability
• Troubleshooting and Production Support
  • Act as an escalation point for complex Facets production issues
  • Analyze batch failures, performance issues and data anomalies
  • Support go-live, hypercare and post-implementation stabilization
  • Partner with infrastructure teams on job scheduling, reruns and environment issues
• Platform and Lifecycle Support
  • Support Facets upgrades, patches and version changes
  • Participate in environment planning (Dev, QA, UAT, Prod) and release cycles
  • Validate technical impacts of configuration and system changes
  • Assist with legacy system migrations and data conversions into Facets
• Documentation and Knowledge Transfer
  • Document technical workflows, batch processes and data dependencies
  • Create troubleshooting guides and root-cause analysis summaries
  • Support knowledge transfer to operations, IT and support teams

Qualifications

• Deep hands-on experience with TriZetto Facets back-end processing
• Strong SQL skills with experience analyzing claims, eligibility and enrollment data
• In-depth understanding of Facets batch architecture and job flows
• Experience troubleshooting complex production issues

Requirements

• Strong understanding of healthcare claims adjudication and enrollment processing
• Experience supporting one or more of the following:
  • Commercial
  • Medicare Advantage
  • Medicaid
  • Marketplace / ACA
• Familiarity with CMS and state Medicaid processing requirements
• Experience supporting EDI transactions (834, 837, encounters)
• Understanding of upstream and downstream system integrations
• Experience working with data warehouses and reporting platforms

Preferred Qualifications

• Facets implementation, upgrade or migration experience
• Experience in consulting or managed services environments
• Familiarity with related TriZetto products (QNXT, NetworX, TMS, Encounter Management)
• Experience supporting large, multi-line-of-business health plans

Soft Skills

• Strong analytical and problem-solving skills
• Ability to communicate complex technical issues clearly to non-technical audiences
• Comfortable operating in fast-paced, production-critical environments
• Strong ownership mindset with attention to detail