Claims Operations (Facets) Lead –
Onshore US Location: United States Seattle, Washington (No remote) Employment Type: Full-Time Experience: 10+ Years
Open Positions: 1
Experience: 10+ Years in Healthcare Payer Operations and Facets Claims Processing Key Responsibilities Lead the end-to-end transition and operational delivery of Facets Claims Operations, ensuring successful knowledge acquisition, operational readiness, stabilization, and seamless transition to steady-state support. Act as the primary client-facing lead and trusted advisor for Claims Operations, managing executive stakeholder relationships, governance forums, risk reviews, and operational decision-making. Partner with client SMEs and business leaders to assess current-state operations, define future-state operating models, and establish service delivery frameworks. Drive transition planning, knowledge transfer execution, readiness assessments, and operational acceptance activities to ensure a successful handoff to delivery teams. Oversee Facets claims adjudication operations, ensuring adherence to productivity, quality, accuracy, turnaround time, and SLA commitments. Establish governance processes, performance metrics, reporting dashboards, and controls to monitor operational performance and deliver continuous visibility to stakeholders. Identify operational risks, process gaps, dependencies, and improvement opportunities, implementing mitigation plans and corrective actions to ensure delivery stability. Collaborate with cross-functional teams including Enrollment, Provider Operations, Configuration, Application Support, and Technology teams to drive end-to-end process effectiveness. Lead continuous improvement, automation, and transformation initiatives to enhance operational efficiency, quality, customer experience, and business outcomes. Provide leadership, coaching, and direction to onshore and offshore operations teams, fostering a culture of accountability, collaboration, and operational excellence. Support workforce planning, capacity management, forecasting, and resource optimization to align with client demand and business objectives. Ensure compliance with healthcare payer regulations, client policies, audit requirements, and operational governance standards. Required Qualifications 10+ years of Healthcare Payer Operations experience with deep expertise in Facets Claims processing and adjudication. Proven experience leading large-scale transition, transformation, and managed services engagements. Strong understanding of Commercial, Medicare, Medicaid, and Government Programs claims operations. Demonstrated success managing client relationships, operational governance, service delivery, and cross-functional teams. Excellent communication, stakeholder management, and leadership skills.
