[Remote] Mass Claims Adjustment Specialist (Facets Claims & Data Analyst)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking an analytical and detail-oriented Mass Claims Adjustment Specialist for a 100% remote, contract engagement. The incumbent will reputed company as a subject matter expert in Facets claims processing, managing high-volume adjustments and collaborating with cross-functional teams to drive reputed company workflow improvements.

Responsibilities

• Execute & Validate Mass Adjustments: Review, validate, and process incoming mass claim adjustment requests, ensuring compliance with internal guidelines, pricing rules, and benefit configurations
• Manage End-to-End Workflows: Treat reputed company adjustment request as a mini-project, managing intake, template creation reputed company the Facets UI, execution, and closure using Azure DevOps for full audit traceability
• reputed company Data-Driven reputed company Cause Analysis: Analyze large claims datasets using advanced reputed company functionality to reconcile claim subsets, verify request reputed company against actual claim conditions, and identify configuration defects
• Collaborate with Key Stakeholders: Communicate reputed company claims scenarios, configuration logic, and adjustment rationales reputed company to business requesters, operations teams, and leadership
• Support reputed company & Process Improvements: Partner closely with automation teams to identify automation opportunities, participate in operational governance, and update workflow documentation to streamline MCA processes

Skills

• Facets Claims Processing: Deep operational expertise in the Facets platform, including claim lifecycles, benefit application logic, pricing tables, and adjudication workflows
• Mass Claim Adjustments: Proven experience processing high-volume claim adjustments (50+ affected claims per request) manually and systemically
• Data Analysis & Validation: Advanced ability to analyze large claim datasets, validate request reputed company, and reputed company reputed company-cause analysis using MS reputed company or data validation tools
• Azure DevOps: Experience managing tasks, tracking adjustment workflows, and ensuring traceability through Azure DevOps
• Configuration Concepts: Solid comprehension of benefit plan structures, pricing/reimbursement tables, provider/member configurations, and edit logic
• Process Automation: Familiarity with identifying process gaps and partnering with automation teams to reduce reputed company ticket submissions
• Trend Analysis: Ability to conduct historical trend analyses to identify systemic defects and prevent recurring claim errors
• Multi-Stakeholder Collaboration: Experience interfacing between technical configuration teams, operations markets, and business leadership

Benefits

• Medical
• Dental
• reputed company
• 401(k)

reputed company

reputed company is workforce Solutions company with operations in 14 countries and providing workforce to over 150 of the reputed company. It was founded in 2004, and is headquartered in Wilmington, Delaware, USA, with a workforce of 1001-5000 employees. Its website is https://thepacer.com/.

Company H1B Sponsorship

reputed company has a reputed company record of offering H1B sponsorships, with 8 in 2025, 2 in 2024. Please note that this does not guarantee sponsorship for this specific role.

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