Job Summary
We are seeking an experienced BPM Claims Operations Lead with strong Healthcare Payer, FACETS Claims Processing, and BPM/BPO expertise to lead operational transitions, service delivery, client governance, and continuous improvement initiatives.
Read on to fully understand what this job requires in terms of skills and experience If you are a good match, make an application.
Mandatory areas – Claims Operations - 10+ years
Must Have skills:
- FACETS
- Healthcare Systems
- Claims Management
- Stakeholder Management
Key Responsibilities
- Lead end-to-end transition, knowledge transfer, operational readiness, and stabilization of FACETS Claims Operations.
- Manage client relationships, stakeholder governance, operational reviews, and risk mitigation.
- Oversee claims adjudication operations, ensuring SLA compliance, quality, accuracy, productivity, and turnaround times.
- Drive process optimization, automation, standardization, and BPM transformation initiatives.
- Manage onshore/offshore teams, workforce planning, capacity management, and resource optimization.
- Establish performance metrics, reporting dashboards, and operational governance frameworks.
- Collaborate with Enrollment, Provider, Billing, Configuration, and Technology teams.
- Ensure compliance with healthcare regulations, client policies, and audit requirements.
Required Qualifications
- 10+ years of Healthcare Payer Operations and BPM/BPO experience.
- Strong expertise in FACETS Claims Processing and Adjudication.
- Experience leading large-scale transitions, transformations, and managed services engagements.
- Knowledge of Commercial, Medicare, Medicaid, and Government Programs claims operations.
- Proven experience in client management, SLA governance, workforce planning, and operational delivery.
- Experience managing large onshore/offshore teams.
- Strong leadership, communication, stakeholder management, and problem-solving skills.
Preferred Qualifications
- Experience leading Healthcare BPM transformation programs.
- Knowledge of Lean Six Sigma, process excellence, automation, and AI-enabled transformation. xhqgsiq
- Exposure to FACETS workflows across Claims, Enrollment, Provider, Billing, and Configuration.
Key Success Metrics
- SLA and KPI compliance
- Claims processing quality and accuracy
- Productivity and turnaround time
- Successful transition and operational stabilization
- Continuous improvement and customer satisfaction
BPM – Claims Operations (FACETS) Lead in seattle at Unknown Company
This position is listed as full time and onsite.