Healthcare Business Configuration Analyst (Facets / SQL Specialty)

We are seeking a specialized Healthcare Business Configuration Analyst to serve as a Subject Matter Expert (SME) for our Managed Vision Care client portfolios. In this role, you won't just input data you will serve as the architect of our benefit structures, utilizing a blend of advanced system configuration tools and deep relational database analysis to ensure seamless, accurate claim adjudication.

If you have 5+ years of experience navigating core claims administration platforms, a mastery of the Facets system, and the SQL skills to pull and analyze data independently,

Required
• Education: Associate degree or equivalent professional experience.
• Core Claims Experience: Minimum of 5 years of hands-on experience working directly within a core healthcare claims administration system.
• SQL Proficiency: Minimum of 2 years of experience writing SQL queries from scratch and exporting relational database tables into Excel for deep-dive analysis.
• Analytical Mindset: Excellent independent problem-solving skills with the ability to manage multiple complex, high-priority assignments at once under strict SLA turnaround times.
• Communication Skills: Strong interpersonal skills to effectively coordinate cross-functional activities and resolve production issues with diverse operational stakeholders.
• 3+ years of operational experience in the Healthcare or Managed Care industries.
• Deep understanding of claim adjudication workflows, specifically regarding member and provider reimbursement structures.
• Direct platform experience with the Cognizant Facets platform, specifically within Claims, Provider, Network, or Product Benefit Configuration modules.
• Informational knowledge of Medicare and Medicaid program guidelines and regulations.

Duties;• Build & Configure: Own the end-to-end structure and setup of managed vision care benefit plans in the Facets system, executing builds via both automated Product Key Sheet (PKS) matrices and precise manual configuration methods.
• Analyze & Troubleshoot: Write complex SQL queries to extract data from database tables into Excel, proactively identifying, analyzing, and resolving system bottlenecks or logic mismatches.
• Ensure Adjudication Accuracy: Safeguard data integrity across configuration tools to eliminate downstream errors for member and provider reimbursements.
• Collaborate Cross-Functionally: Manage your production queue independently while maintaining strong, results-driven partnerships with Implementation Managers, Account Managers, and Claims Operations.
• Drive Continuous Improvement: Recommend process and system enhancements to streamline builds, and support the management team with ongoing training activities and technical mentorship for junior team members.