Facets Process & Documentation Specialist

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Create and document thorough Desk Level Procedures (DLPs) for health plan operations.

• Convert business processes and Facets functionality into clear, sequential operational guidelines.

• Establish standard workflows, processes for handling exceptions, and procedures for resolving issues.

• Ensure DLPs are consistent with Facets configurations across membership, billing, claims, benefits, provider, and pricing modules.

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

• Assist in troubleshooting claims and benefit issues arising from configuration discrepancies or system logic.

• Validate claims, adjudication workflows, and system interdependencies.

• Formulate procedures for error investigation, configuration issue identification, and executing corrections and reprocessing.

• Outline steps for root-cause identification, resolution actions, escalation paths, and cross-team dependencies.

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

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

• Simplify complex technical and system concepts into user-friendly documentation.

• Contribute to training initiatives with DLP documentation and operational guidance.

• Continuously improve DLPs to enhance efficiency, accuracy, consistency, issue-resolution timelines, and standardization.

• Assist in 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 the healthcare payer sector, including Medicare and Medicaid.

• At least 5 years of practical experience with claims systems such as Facets, QNXT, or HealthRules.

• Familiarity with premium billing, claims processing, benefits/provider configuration, and operational workflows.

• Solid experience in developing Desk Level Procedures (DLPs), SOPs, workflows, or operational documentation.

• Profound understanding of eligibility and premium billing.

• Comprehensive knowledge of claims adjudication processes.

• In-depth understanding of benefits configuration and plan structures.

• Demonstrated ability to convert complex processes into clear, step-by-step instructions.

• Proven capability to troubleshoot and resolve system/process-related issues.

• Experience in a consulting or client-facing role.

• Background in creating training materials or user guides.

• Familiarity with AI tools, including Copilot, ChatGPT, and Claude.

🏝️ Benefits

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

• 401(k) plan with a substantial employer match.

• Employee stock purchase plan.

• Generous Paid Time Off policy.

• Paid parental leave.

• Adoption assistance.

• Wellness Program offering free annual health screenings and coaching.

• Bank at work facilities.

• On-site workshops available.

• Continuous programs recognizing significant employee life events.

• Annual incentive compensation program.

• Additional wellness initiatives.