Job Description

We are seeking an experienced Optum CES Implementation Consultant with a strong background in Facets Configuration to support one of our clients in optimizing claims editing and adjudication processes. The ideal candidate will have deep expertise in Optum CES (Optum Claims Edit System) and Facets Configuration, bringing at least 5+ years of hands-on experience in both domains.

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Key Responsibilities:

• Lead and execute Optum CES implementations, ensuring seamless integration with Facets.
• Configure and optimize Facets to support claims processing and business requirements.
• Analyze, design, and implement claims editing rules and configurations within Optum CES.
• Collaborate with cross-functional teams to enhance claims adjudication workflows.
• Troubleshoot and resolve system configuration issues related to Optum CES and Facets.
• Provide strategic guidance to clients on best practices for claims editing and compliance.
• Conduct testing, validation, and documentation for system changes and enhancements.

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Required Qualifications:

• 5+ years of experience with Facets Configuration.
• 5+ years of experience with Optum CES (Optum Claims Edit System).
• Strong understanding of claims processing and adjudication in a healthcare payer environment.
• Experience working with or for TriZetto is highly preferred.
• Ability to analyze and configure system rules to meet business requirements.
• Excellent problem-solving skills with a detail-oriented mindset.
• Strong communication skills for client-facing interactions and project collaboration.

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Preferred Qualifications:

• Experience with Optum CES Implementation and integrations.
• Experience with TriZetto Facets Configuration.
• Knowledge of EDI transactions, provider reimbursement, and claims workflows.
• Prior experience in a consulting or healthcare IT environment.