DLP, Desk Level Procedures Manager

📋 Description

• Create and document thorough Desk Level Procedures (DLPs) across workflows related to claims, benefits, enrollment, and configuration.

• Convert business processes and system functionalities into well-defined, step-by-step operational procedures for end users.

• Develop DLPs that detail:

• Standard workflows

• Exception handling processes

• Detailed issue resolution procedures

• Ensure that documentation is precise, comprehensive, and consistent with the current behavior of the Facets system and applicable business rules.

• Collaborate with configuration teams to align DLPs with the Facets system setup pertaining to membership, billing, claims, benefits, provider, and pricing modules.

• Translate configuration logic into operational procedures for claims processing, adjustments, and issue resolution.

• Assist in troubleshooting claims and benefit-related problems associated with configuration gaps or system logic.

• Validate that operational processes accurately reflect claims adjudication workflows and system dependencies.

• Provide extensive subject matter expertise in:

• Membership and premium billing

• Claims adjudication workflows

• Benefits configuration and plan design

• Provider payment and reimbursement processes

• Develop procedures that assist teams in:

• Investigating errors

• Identifying configuration issues

• Executing corrections and reprocessing steps

• Ensure that procedures facilitate consistent and compliant claims and benefits operations.

• Create DLPs that clearly define:

• How to identify root causes of claims or configuration issues

• Step-by-step actions for resolving issues within Facets or related systems

• Escalation paths and inter-team dependencies

• Collaborate with operational and IT teams to analyze recurring issues and enhance existing procedures.

• Promote consistency in how teams diagnose and resolve claims, configuration, and workflow issues.

• Work with Claims, Enrollment, Provider Configuration, IT, and Operations teams to define and validate processes.

• Simplify complex technical and system concepts for clear, business-friendly documentation.

• Support training initiatives by providing DLP documentation and operational guidance to end users.

• Regularly assess and improve DLPs to enhance:

• Operational efficiency

• Accuracy and consistency

• Timeliness of issue resolution

• Standardized procedures across clients and environments to ensure repeatable and scalable delivery models.

• Assist with system implementations, conversions, and operational transformations through DLP development.

⛳️ Requirements

• Over 5 years of experience in Healthcare Payer operations.

• More than 5 years of experience in healthcare payer environments (Medicare and Medicaid).

• At least 5 years of hands-on experience with Facets (TriZetto), especially in:

• Premium billing

• Claims processing

• Benefits/Provider configuration

• Operational workflows

• Strong background in developing:

• Desk Level Procedures (DLPs)

• Standard Operating Procedures (SOPs), workflows, or operational documentation.

• In-depth understanding of:

• Eligibility and premium billing

• Claims adjudication processes

• Benefits configuration and plan structures

• Demonstrated ability to:

• Translate intricate processes into clear, step-by-step instructions

• Troubleshoot and resolve system and process-related issues.

• Experience in a consulting or client-facing role.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage for employees and their dependents.

• A 401(k) plan featuring a generous employer match.

• An employee stock purchase plan.

• A generous Paid Time Off policy.

• Paid parental leave and adoption assistance.

• Our Wellness Program promotes employee well-being by offering free annual health screenings and coaching, banking at work, on-site workshops, and ongoing programs that celebrate significant events in our employees' lives throughout the year.