Healthcare Benefits Plan Quality Analyst

The Product/Benefits Plan Configuration QA Analyst is responsible for independently validating product and group configurations in TriZetto Facets to ensure accuracy, completeness, and compliance with approved business requirements. This role performs quality audits, configuration testing, defect analysis, and root cause investigations while supporting defect prevention and continuous quality improvement initiatives.

Key Responsibilities

Quality Validation

• Review configured products, groups, accounts, and benefit plans against source documentation.
• Validate configuration accuracy across benefit structures, eligibility rules, accumulators, provider networks, and plan attributes.
• Ensure TriZetto Facets configurations align with contract requirements and approved business rules.
• Conduct comprehensive quality reviews before production deployment.

Testing Activities

• Execute configuration validation testing in TriZetto Facets.
• Perform end-to-end testing of benefit and group configurations.
• Validate downstream impacts on enrollment, claims, and member servicing processes.
• Support User Acceptance Testing (UAT) and production verification activities.

Defect Analysis & Root Cause Analysis

• Identify configuration defects and quality gaps.
• Classify and trend configuration errors.
• Conduct root cause analysis across people, process, and system dimensions.
• Recommend corrective and preventive actions.

Calibration & Reporting

• Participate in quality calibration sessions.
• Maintain audit scorecards and quality reporting metrics.
• Analyze defect trends and quality performance indicators.
• Provide actionable recommendations to configuration leadership.

Compliance & Governance

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

Mandatory Skills & Competencies

• Strong knowledge of healthcare payer product and group configuration in TriZetto Facets.
• Experience reviewing benefit plans and group setup documents.
• Strong analytical, testing, and auditing skills.
• Ability to identify defects and perform root cause analysis.
• Excellent documentation and reporting capabilities.