Lead II - BPM-BPM Configuration Lead

About The Job:

• BPM Configuration Lead with 8+ years of Healthcare Payer and BPM experience, possessing strong understanding of Claims, Enrollment, Billing, Provider, and Benefit Administration processes.
• Hands-on TriZetto FACETS Configuration experience, including Product Configuration, Group Setup, Benefits Configuration, and Claims Adjudication Rules.
• Proven experience supporting large-scale healthcare payer implementations, operational excellence initiatives, process governance, SLA adherence, and continuous improvement programs.

Essential Job Functions:

• Lead and oversee Product Configuration, Group Setup, Benefits Configuration, and Claims Adjudication Rule implementation within TriZetto FACETS.
• Configure and maintain Product Shells & Finals, Benefit Plans, and BQT Templates.
• Configure Deductibles, Copays, Coinsurance, Network and Service Payment Rules.
• Manage Group, Subgroup, Class Plan, and Billing Structures configuration.
• Ensure accurate configuration-driven adjudication and benefit interpretation.
• Lead Configuration Analysts and cross-functional teams through planning, mentoring, reviews, and delivery oversight.
• Support healthcare BPM/BPO operations by driving process governance, quality standards, and SLA compliance.
• Collaborate with business stakeholders to translate requirements into FACETS configuration solutions.
• Support configuration migration activities, release management, testing, and implementation.
• Drive operational excellence, process transformation, and continuous improvement initiatives.
• Ensure compliance with HIPAA, healthcare regulations, audit controls, and quality standards.

Qualifications:
Required Skills & Experience

• 8+ years of Healthcare Payer and BPM experience.
• Strong understanding of Claims, Enrollment, Billing, Provider, and Benefit Administration processes.
• Hands-on experience with TriZetto FACETS Configuration.
• Strong knowledge of FACETS Claims Processing, Benefit Interpretation, and Configuration-driven Adjudication.
• Experience configuring:
  • Product Shells & Finals
  • Benefit Plans
  • BQT Templates
  • Deductibles, Copays, Coinsurance
  • Network and Service Payment Rules
  • Group, Subgroup, Class Plan, and Billing Structures
• Experience leading Configuration Analysts and cross-functional teams.
• Working knowledge of Healthcare EDI transactions (834/837).
• Working knowledge of SQL, ServiceNow, Azure DevOps, and configuration migration processes.
• Strong understanding of HIPAA, healthcare compliance, audit controls, and quality standards.
• Excellent communication, stakeholder management, and problem-solving skills.

Preferred Qualifications

• FACETS Certification.
• Experience supporting large-scale healthcare payer implementations and transformations.
• Experience in Healthcare BPM operations and process transformation initiatives.

Skills

• SQL
• FACETS
• ServiceNow
• HIPAA

How to Apply:Interested candidates are encouraged to respond/submit their updated resumes, and for additional job opportunities, please visitJobs In India – VARITE.

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About VARITE: VARITE is a global staffing and IT consulting company providing technical consulting and team augmentation services to Fortune 500 Companies in USA, UK, CANADA and INDIA. VARITE is currently a primary and direct vendor to the leading corporations in the verticals of Networking, Cloud Infrastructure, Hardware and Software, Digital Marketing and Media Solutions, Clinical Diagnostics, Utilities, Gaming and Entertainment, and Financial Services.

Equal Opportunity Employer:
VARITE is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, marital status, veteran status, or disability status.