Lead I – BPM Product Configuration Lead

Lead I – BPM Product Configuration Lead

Experience

8+ years of healthcare payer configuration and BPM operations experience, including 3+ years in a Lead, Supervisory, or Operations Management role.

Role Summary

The BPM Product Configuration Lead will oversee end-to-end product and group configuration activities within the TriZetto Facets platform while driving operational excellence through BPM methodologies.

The role will lead new group implementations, benefit plan configuration, renewals, maintenance, quality governance, and production readiness, ensuring compliance with business requirements, SLAs, quality standards, and BPM best practices.

Key Responsibilities

1. Configuration Leadership

• Lead end-to-end product, group, account, and benefit configuration activities in TriZetto Facets.
• Manage new group setups, renewals, amendments, and maintenance requests.
• Provide oversight to configuration analysts, BPM associates, QA analysts, and cross-functional teams.
• Ensure implementation timelines, project milestones, and operational SLAs are met.
• Coordinate configuration releases, deployments, and production readiness.

2. BPM & Operational Excellence

• Drive BPM initiatives to improve configuration accuracy, efficiency, and productivity.
• Analyze, document, and optimize configuration workflows and operational processes.
• Develop and maintain SOPs, process maps, operational controls, and knowledge repositories.
• Identify improvement opportunities using Lean, Six Sigma, and continuous improvement methodologies.
• Monitor operational metrics and establish process governance.
• Support transition, migration, and stabilization activities.

3. Functional Oversight

• Review and interpret PDRs, benefit documents, contracts, and group setup requirements.

• Translate business requirements accurately into TriZetto Facets configurations.

• Resolve complex configuration scenarios involving:

• Benefit structures

• Eligibility rules

• Accumulators

• Provider networks

• Pricing dependencies

• Provide guidance on healthcare product design and configuration standards.

4. Governance & Quality

• Establish configuration standards, quality controls, audit requirements, and BPM governance frameworks.
• Conduct quality reviews, calibration sessions, and process audits.
• Lead RCA for configuration defects, process gaps, and production issues.
• Monitor defect trends and implement corrective and preventive actions.
• Ensure compliance with regulatory, contractual, business, and operational requirements.

5. Stakeholder Management

• Partner with Product, Underwriting, Enrollment, Claims, Operations, BPM, and IT teams.
• Act as the primary escalation point during group implementations and renewals.
• Participate in governance meetings, operational reviews, and status discussions.
• Support business readiness and operational stabilization.

6. Continuous Improvement

• Drive process standardization and best-practice adoption.
• Identify automation opportunities to reduce manual effort, defects, and turnaround time.
• Support AI-enabled configuration validation, workflow automation, and testing initiatives.
• Improve delivery efficiency through workflow optimization and operational excellence programs.

Mandatory Skills

• TriZetto Facets – Product & Group Configuration
• Healthcare Payer / Plan Configuration
• Benefit Plan Design, Accumulators & Eligibility
• BPM Operations & Process Governance
• Group Implementations & Renewals
• Quality Management, RCA & Defect Prevention
• Team & People Leadership
• Stakeholder Management
• Operational Excellence / Process Improvement
• 8+ years healthcare payer configuration & BPM
• 3+ years Lead/Supervisory experience
• Commercial, ACA, Medicare and/or Medicaid experience

Preferred Skills

• Lean Six Sigma
• Claims Management
• Large-scale Group Implementations
• Shared Services / Managed Services BPM
• Process Automation
• AI-enabled Configuration Validation
• Transition, Migration & Stabilization

Qualifications

• Bachelor's degree in Business, Healthcare Administration, Information Systems, Engineering, or related field.
• 8+ years of healthcare payer configuration and BPM operations experience.
• Minimum 3+ years in a Lead, Supervisory, or Operations Management role.
• Experience with healthcare payer BPM, shared services, or managed services environments is preferred.

Required Platform

Hands-on expertise in TriZetto Facets product, benefit, and group configuration.

Healthcare Product Exposure

• Commercial
• ACA
• Medicare
• Medicaid