Role Purpose
The purpose of this role is to analyse client business processes and conduct detailed market and benchmarking studies to evaluate process improvement opportunities and propose enhancements.
Role: Senior Facets / Java Developer – Medicaid Regulatory Solutions
Key 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.
Required Experience
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:
Membership
Eligibility
Benefits
Claims
Claims adjudication
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.
Mandatory Skills: HC - Payor
Experience: 5-8 Years
The expected compensation for this role ranges from $60,000 to $135,000 .
Final compensation will depend on various factors, including your geographical location, minimum wage obligations, skills, and relevant experience. Based on the position, the role is also eligible for Wipro's standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options.
Applicants are advised that employment in some roles may be conditioned on successful completion of a post-offer drug screening, subject to applicable state law.
Wipro provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. Applications from veterans and people with disabilities are explicitly welcome.
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