Mass Claims Adjustment Specialist (Facets Claims & Data Analyst)

Job Title: Mass Claims Adjustment Specialist (Facets Claims & Data Analyst) Location: Remote Work Arrangement: Remote Employment Type: Contract Contract Duration: 6+ Months (with potential for extension) Hourly Rate: $30.00/hr. to $32.43/hr. Domain: Healthcare Insurance | Claims Operations Application Deadline: August 28, 2026 SKILLS REQUIRED: Primary (Must-Have): ✔️Facets Claims Processing: Deep operational expertise in the Facets platform, including claim lifecycles, benefit application logic, pricing tables, and adjudication workflows. ✔️Mass Claim Adjustments: Proven experience processing high-volume claim adjustments (50+ affected claims per request) manually and systemically. ✔️Data Analysis & Validation: Advanced ability to analyze large claim datasets, validate request criteria, and perform root-cause analysis using MS Excel or data validation tools. ✔️Azure DevOps: Experience managing tasks, tracking adjustment workflows, and ensuring traceability through Azure DevOps. ✔️Configuration Concepts: Solid comprehension of benefit plan structures, pricing/reimbursement tables, provider/member configurations, and edit logic. Secondary (Good to Have): ✔️Process Automation: Familiarity with identifying process gaps and partnering with automation teams to reduce manual ticket submissions. ✔️Trend Analysis: Ability to conduct historical trend analyses to identify systemic defects and prevent recurring claim errors. ✔️Multi-Stakeholder Collaboration: Experience interfacing between technical configuration teams, operations markets, and business leadership. POSITION OVERVIEW: We are seeking an analytical and detail-oriented Mass Claims Adjustment Specialist for a 100% remote, contract engagement. Sitting within the core Claims Operations division, the incumbent will act as a subject matter expert in Facets claims processing, treating each incoming mass adjustment request (50+ claims) as a structured mini-project. This role is crucial for executing high-volume adjustments, validating downstream operational impacts, and partnering with cross-functional teams to identify root causes and drive continuous workflow improvements. ROLES & RESPONSIBILITIES: ✔️Execute & Validate Mass Adjustments: Review, validate, and process incoming mass claim adjustment requests, ensuring compliance with internal guidelines, pricing rules, and benefit configurations. ✔️Manage End-to-End Workflows: Treat each adjustment request as a mini-project, managing intake, template creation within the Facets UI, execution, and closure using Azure DevOps for full audit traceability. ✔️Perform Data-Driven Root Cause Analysis: Analyze large claims datasets using advanced Excel functionality to reconcile claim subsets, verify request criteria against actual claim conditions, and identify configuration defects. ✔️Collaborate with Key Stakeholders: Communicate complex claims scenarios, configuration logic, and adjustment rationales clearly to business requesters, operations teams, and leadership. ✔️Support Quality & Process Improvements: Partner closely with automation teams to identify automation opportunities, participate in operational governance, and update workflow documentation to streamline MCA processes. BENEFITS Medical | Dental | Vision | 401(k) EEOC Compliance We are an equal opportunity employer, and all qualified applicants will receive consideration for employment. DISCLAIMER AI Usage Policy: Pacer Group uses AI to assist in screening applications. Final hiring decisions are made by human recruiters based on qualifications and experience.