[Remote] 100% Remote // Java Facets Developer (Eligibility, Medicaid, Claims)

Note: The job is a remote job and is open to candidates in USA. Talent Groups is seeking an experienced developer to implement state-specific Medicaid regulatory changes across Facets and related healthcare applications. The role translates regulatory and business requirements into system configuration, Java and Mainframe application changes, integrations, and data-processing solutions in collaboration with regulatory, business, architecture, and QA teams.

Responsibilities

• Analyze regional/state Medicaid regulatory requirements and translate them into technical changes across Facets and surrounding applications
• Design, develop, configure, and maintain solutions supporting:
• Member enrollment and eligibility
• Membership maintenance
• Benefits and plan configuration
• Claims intake and adjudication
• Claims pricing and payment
• Provider-related claim processing
• Medicaid-specific edits and business rules
• Medicare/Medicaid coordination where applicable
• Develop and enhance Java-based applications, APIs, interfaces, batch programs, and integration components supporting Facets
• Develop or modify Mainframe programs and batch-processing components supporting Medicaid processes
• Perform Facets configuration and development associated with regulatory and business-rule changes
• Build and maintain ETL/data integration solutions using IBM DataStage and Talend/TalendWorks
• Analyze upstream and downstream impacts of regulatory changes across Facets, data platforms, interfaces, and surrounding applications
• Conduct code reviews, unit testing, defect resolution, root-cause analysis, and technical quality assessments
• Support system integration testing, regression testing and production implementation
• Troubleshoot complex claims, membership, eligibility, and regulatory processing issues
• Develop reusable engineering approaches where regulatory requirements are common while accommodating state-specific variations
• Maintain technical specifications, mappings, configuration documentation, traceability and implementation artifacts

Skills

• Strong hands-on experience with TriZetto Facets
• Strong Java/J2EE engineering and programming skills
• Experience with IBM DataStage and Talend/TalendWorks or comparable enterprise ETL technologies
• Strong understanding of Medicaid managed-care operations and state-specific regulatory requirements
• Experience implementing regulatory or business-rule changes within healthcare payer platforms
• Strong Facets experience in: o Membership o Eligibility o Benefits o Claims o Claims adjudication o Pricing/payment processing
• Good understanding of both Medicaid and Medicare health-plan processes
• Experience with SQL, databases, batch processing, APIs/interfaces and data integration
• Strong debugging, production support and root-cause-analysis skills
• Ability to interpret business/regulatory requirements and convert them into detailed technical solutions
• Medicare-Medicaid / dual-eligible experience
• Experience working with multiple state Medicaid programs
• Experience supporting large health plans or Medicaid MCO environments
• Healthcare EDI/X12 knowledge
• Knowledge of automated CI/CD, code quality and test automation practices

Benefits

• 100% Remote

Company Overview

Company H1B Sponsorship