Job Summary

We are seeking an experienced Facets and SQL Healthcare Professional with solid expertise in TriZetto Facets, Healthcare Payer Operations, and SQL Development. The ideal candidate will have hands-on experience in healthcare enrollment, claims, provider, billing, and membership domains, along with strong analytical and troubleshooting skills. The resource will work closely with business stakeholders, developers, QA teams, and production support teams to deliver high-quality healthcare solutions.

Key Responsibilities

Facets Responsibilities

- Analyze and support Facets modules including:
- - Membership & Enrollment
- Claims Processing
- Provider Management
- Billing & Premium Management
- Authorization & Referrals

- Perform configuration and maintenance activities in Facets.
- Investigate and resolve production issues related to claims, enrollment, and billing.
- Conduct impact analysis for system changes and enhancements.
- Collaborate with business and operational teams to gather and validate requirements.

SQL Responsibilities

- Develop and optimize complex SQL queries, stored procedures, views, and reports.
- Perform data analysis, data validation, and reconciliation activities.
- Support data extraction for business and regulatory reporting.
- Analyze source-to-target data mappings.
- Troubleshoot data quality and performance issues.
- Create ad hoc reports and dashboards as needed.

Healthcare Domain Responsibilities

- Understand healthcare payer workflows and business processes.
- Analyze claims adjudication and membership enrollment transactions.
- Support Medicare, Medicaid, Commercial, and Marketplace lines of business.
- Ensure compliance with healthcare regulations and business requirements.
- Participate in testing, defect analysis, and production support activities.

Required Technical Skills

Healthcare

- Healthcare Payer Domain
- Claims Processing
- Membership & Enrollment




- Provider Management
- Billing & Premium Management
- EDI Transactions (834, 835, 837, 270/271)

Facets

- Facets Data Model
- Facets Configuration
- Facets Batch Processes
- Facets Inquiry Screens
- Facets Production Support

Database

- SQL Server / Oracle
- Complex SQL Queries
- Stored Procedures
- Performance Tuning
- Data Analysis & Reporting

Tools

- Azure DevOps
- ServiceNow
- SSMS / TOAD
- Microsoft Visual Studio

Preferred Qualifications

- Experience with Healthcare Data Warehousing.
- Experience with APIs and Healthcare Integrations.
- Knowledge of Kafka, ETL, or Data Migration projects.
- Understanding of HIPAA compliance requirements.

Soft Skills

- Strong analytical and problem-solving skills.
- Excellent communication and stakeholder management.
- Ability to work independently and within cross-functional teams.
- Strong documentation and knowledge transfer skills.
- Ability to handle multiple priorities in a fast-paced environment.

Skill Requirements

- 5+ years of Healthcare Payer experience.
- 3+ years of hands-on experience with TriZetto Facets.
- Strong SQL development and data analysis experience.
- Experience working with large healthcare datasets.
- Experience in Agile/Scrum environment.
- Knowledge of Healthcare EDI Transactions (834, 835, 837, 270/271, 276/277).

Must Have Skill

Electronic Data Interchange (EDI),Healthcare Product Configuration (Facets),SQL Proficiency,US Healthcare - Payer

Good to Have Skill

Apache Kafka

Other Requirements

- Strong analytical and problem-solving skills.
- Excellent communication and stakeholder management.
- Ability to work independently and within cross-functional teams.
- Strong documentation and knowledge transfer skills.
- Ability to handle multiple priorities in a fast-paced environment.

Nice to Have

- Facets Certification.
- Experience in cloud environments (Azure).
- Knowledge of APIGEE, Kafka, and Microservices architecture.

📌 Senior Technical Lead (Gautam Buddh Nagar)
🏢 HCLTech
📍 Gautam Buddh Nagar