Claims Operations (Facets) Lead

Role: Claims Operations (Facets) Lead Onshore US 

Location: United States Seattle, Washington (No remote)

Employment Type: Full-Time Experience: 10 Years

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.