Associate III - BPM

Job Title

Product Configuration QA Analyst – Healthcare Payer (TriZetto Facets)

Location - Chennai/ Bangalore

Experience - 3 to 6 Years

Job Summary

We are seeking an experiencedProduct Configuration QA Analyst with strong expertise inHealthcare Payer Operations and TriZetto Facets. The ideal candidate will be responsible for validating and auditing product, benefit, and group configurations to ensure accuracy, compliance, and alignment with approved business requirements. This role requires strong analytical, testing, auditing, and defect management skills with a focus on quality improvement and defect prevention.

Key Responsibilities

Configuration Quality Validation

• Review and validate product, group, account, and benefit configurations against source documentation.
• Audit eligibility rules, benefit structures, accumulators, provider networks, and plan attributes.
• Ensure configurations comply with contractual requirements and approved business rules.
• Perform quality reviews and sign-off activities before production deployment.

Testing & Validation

• Execute configuration validation and functional testing within TriZetto Facets.
• Perform end-to-end testing of product and group configurations.
• Validate downstream impacts on enrollment, claims processing, and member servicing functions.
• Support User Acceptance Testing (UAT) and post-production verification activities.

Defect Management & Root Cause Analysis

• Identify configuration defects and quality issues.
• Analyze defect trends and recurring quality gaps.
• Conduct root cause analysis (RCA) across people, process, and technology areas.
• Recommend corrective and preventive actions to improve quality outcomes.

Reporting & Quality Governance

• Participate in calibration and quality review sessions.
• Maintain audit scorecards, quality metrics, and reporting dashboards.
• Track audit accuracy, defect leakage, and first-pass quality metrics.
• Present findings and improvement recommendations to leadership teams.

Compliance & Documentation

• Ensure adherence to configuration standards, policies, and procedures.
• Support audit readiness and documentation requirements.
• Validate compliance with regulatory, contractual, and organizational standards.

Required Skills & Competencies

• Strong experience inTriZetto Facets Product, Benefit, and Group Configuration.
• Healthcare payer domain expertise.
• Configuration Quality Assurance (QA) and audit experience.
• Functional Testing and End-to-End Testing.
• Defect Management and Root Cause Analysis.
• Claims Management knowledge.
• Strong analytical and problem-solving abilities.
• Excellent documentation and reporting skills.
• Ability to work independently and manage multiple priorities.

Required Experience

• 5+ years of Healthcare Payer Configuration experience.
• 2+ years of Configuration QA, Validation, or Audit experience.
• Hands-on experience reviewing and validating benefit plans and group setup documentation.
• Experience testing and validating product, benefit, and group configurations in TriZetto Facets.

Education

• Bachelor's Degree or equivalent relevant experience.

Preferred Qualifications

• Experience supporting healthcare enrollment and claims processes.
• Exposure to quality metrics, audit frameworks, and continuous improvement initiatives.
• Knowledge of healthcare regulations and compliance requirements.

Key Skills

• TriZetto Facets
• Product Configuration
• Group Configuration
• Benefit Configuration
• Healthcare Payer
• Functional Testing
• End-to-End Testing
• Claims Management
• UAT
• Root Cause Analysis (RCA)
• Defect Management
• Quality Assurance
• Audit & Compliance
• Provider Networks
• Eligibility Rules
• Accumulators

Key Performance Indicators (KPIs)

• Audit Accuracy Rate
• Defect Identification Rate
• Defect Leakage Rate
• First-Pass Quality
• Audit Completion Turnaround Time
• Calibration Consistency Score
• RCA Effectiveness