BPM Configuration Lead

Experience

8+ Years

Job Summary

We are looking for an experienced BPM Configuration Lead with strong expertise in US Healthcare Payer and BPM operations. The role requires a deep understanding of Claims, Enrollment, Billing, Provider, and Benefit Administration processes, along with hands-on experience in TriZetto FACETS Configuration.

The ideal candidate will have experience in Product Configuration, Group Setup, Benefits Configuration, and Claims Adjudication Rules, along with the ability to lead configuration teams and translate business requirements into effective FACETS configuration solutions.

Key Responsibilities

FACETS Configuration

- Perform hands-on configuration activities in TriZetto FACETS.
- Configure Product Shells and Finals Benefit Plans.
- Configure BQT Templates.
- Configure deductibles, copays, coinsurance, network and service payment rules.
- Configure Group, Subgroup, Class Plan, and Billing structures.
- Support configuration-driven claims adjudication and benefit interpretation.

Team & Stakeholder Management

- Lead and mentor Configuration Analysts.
- Plan and allocate configuration activities and review deliverables.
- Coordinate with cross-functional teams and stakeholders.
- Translate business requirements into appropriate FACETS configuration solutions.

Healthcare BPM & Operations

- Support Healthcare BPM/BPO operations and operational excellence initiatives.
- Drive process governance, SLA adherence, quality, and continuous improvement.




- Support healthcare payer implementations and transformation initiatives.

Integration & Technical Support

- Work with healthcare EDI transactions, including 834 and 837.
- Utilize SQL for configuration validation and analysis.
- Work with ServiceNow and Azure DevOps as required.
- Support configuration migration processes across environments.

Compliance & Quality

- Ensure adherence to HIPAA, healthcare compliance, audit controls, and quality standards.
- Support configuration reviews, audits, and governance activities.
- Ensure configuration activities align with defined standards and business requirements.

Mandatory Skills TriZetto FACETS Configuration | Healthcare Payer | BPM/BPO | Product Configuration | Advantages Configuration | Group Setup | Claims Adjudication | Benefit Administration | SQL | ServiceNow | Azure DevOps | HIPAA

Preferred Skills

FACETS Certification | Large-Scale Healthcare Payer Implementations | Healthcare EDI (834/837) | Configuration Migration | Healthcare Transformation | Process Governance | Operational Excellence

Qualifications & Experience

- 8+ years of experience in Healthcare Payer and BPM.
- Strong hands-on experience with TriZetto FACETS Configuration.
- Experience across Claims, Enrollment, Billing, Provider, and Benefit Administration.
- Proven experience leading Configuration Analysts or cross-functional teams.
- Experience in Healthcare BPM/BPO environments.
- Strong communication and stakeholder management skills.

Pay: ₹60,000.00 - ₹100,000.00 per month

Work Location: In person

📌 BPM Configuration Lead(Lead II - BPM-BPM Configuration Lead) (Thiruvananthapuram)
🏢 Knowledge Artisans Private
📍 Thiruvananthapuram