Pricing Configuration Manager

CareMore Health

. Lead the Configuration team within Provider Setup and translate health plan contracts, medical policies, business rules, benefit designs, and provider pricing requirements into accurate, scalable system configuration .

Posted 11/11/2026full-timeRemote • United StatesSeniorLead💰 $108,466 - $162,698 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in healthcare payer operations, particularly in claims configuration, provider pricing, and benefit design using TriZetto Facets. Proven ability to lead teams, manage performance, and implement effective configuration solutions that enhance claims processing and regulatory compliance.

Highest-signal resume keywords

TriZetto Facets ConfigurationClaims Configuration and AdjudicationPeople Management and Team LeadershipSQL-Based Validation and Root Cause AnalysisHealthcare Coding Standards (CPT, ICD-10, HCPCS)

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims ConfigurationProvider PricingCapitation ArrangementsBenefit ConfigurationSQL ValidationRoot Cause AnalysisConfiguration ManagementWorkflow AutomationData Interchange Transactions (837/835)Performance Management

Soft Skills

CoachingTrainingCommunicationProblem-SolvingCollaboration

Tools & Technologies

TriZetto FacetsFacets Configuration Management UtilityClaims-Pricing ToolsWorkflow-Management Platforms

Industry Keywords

Healthcare Payer OperationsRegulatory ComplianceClaims AdjudicationMedicare AdvantageService-Level Performance

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Lead the Configuration team within Provider Setup and translate health plan contracts, medical policies, business rules, benefit designs, and provider pricing requirements into accurate, scalable system configuration
Own team performance, configuration quality, delivery controls, and continuous improvement supporting claims adjudication, auto-adjudication, regulatory compliance, and integration across pricing, provider, benefits, enrollment, and claims functions
Manage and develop Configuration analysts; assign work; establish priorities and capacity plans; evaluate performance; provide training, coaching, technical development, succession planning, and career-development opportunities
Lead interviews and recommend hiring decisions for the Director’s final approval
Direct daily Configuration operations, including work intake, prioritization, capacity allocation, service-level performance, quality controls, backlog management, cross-functional project teams, and large-scale platform or health plan implementations
Report results, risks, and corrective actions to the Director
Oversee provider pricing and capitation arrangements, CMS fee schedules, benefit configuration, and workflow setups within TriZetto Facets and related tools
Coordinate claims, pricing, benefit, and workflow configuration dependencies and handoffs across Provider Data Management, Practitioner Management, Network Management, enrollment, and NetworX/ITS functions
Partner with Claims, Claims Audit, Payment Integrity, Operations, Finance, Network Management, IT, and business stakeholders to translate plan documents, provider contracts, benefit designs, medical policies, business rules, network requirements, and regulatory requirements into testable system specifications
Design and implement configuration solutions for complex provider pricing, capitation, and benefit arrangements
Lead production troubleshooting and root cause analysis for claims processing errors, matching issues, cost shares, pricing discrepancies, coordination-of-benefits failures, and configuration-related pends
Implement corrective and preventive actions and verify sustained resolution
Manage configuration promotion and change-control processes, including requirements documentation, approval documentation, peer review, testing evidence, migrations, segregation of duties, post-production validation, and audit readiness
Coordinate configuration activities for system upgrades, patches, releases, vendor-supported changes, impact assessment, testing, migration planning, and production validation
Serve as the subject-matter expert for TriZetto Facets configuration strategy and recommend changes that improve claims workflow efficiency and accurate auto-adjudication

Requirements

What you’ll need

Bachelor’s degree in Information Technology, Healthcare Administration, Business, or a related field, or an equivalent combination of education and relevant healthcare payer operations experience
At least 10 years of progressive healthcare payer operations and technology experience, including substantial experience with claims, provider pricing, capitation, or benefit configuration using TriZetto Facets or another payer technology platform
At least three years of direct people-management experience leading configuration analysts or comparable healthcare payer operations or technology teams, including responsibility for performance management, coaching, workload planning, and hiring
Deep knowledge of claims configuration and adjudication logic, provider pricing and capitation arrangements, CMS fee schedules, benefit configuration, cost-share logic, claims workflow dependencies, and accurate and timely claims payment
Demonstrated ability to use SQL-based validation, claims data, operational metrics, and root cause analysis to test configuration and resolve defects
Working knowledge of electronic data interchange transactions such as 837/835 and healthcare coding standards including CPT, ICD-10, and HCPCS
Experience leading configuration work through platform upgrades, patch applications, release testing, configuration migrations, production validation, and post-implementation stabilization
Preferred: Experience with TriZetto Facets, the Facets Configuration Management Utility, Medicare Advantage, delegated-risk arrangements, benefits automation, claims-pricing tools, or workflow-management platforms
Preferred: Demonstrated success improving accurate and timely claims payment, auto-adjudication, service-level performance, configuration quality, and career development within a highly experienced team