Facets Product & Benefits Senior Analyst Resume

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Facets Product & Benefits Senior Analyst Resume Adam Morton Facets Product & Benefits Senior Analyst (612) 555-7364 adam.morton@example.com linkedin.com/example/adammorton Minneapolis, MN 55416 STRENGTHS Benefit configuration Translated plan intent into accurate Facets rules, then checked claims results until business partners trusted each release. Root cause analysis When claims looked wrong, traced records across systems and found durable fixes instead of temporary workarounds. Cross functional delivery Brought product, claims, pricing, eligibility, networks, and QA into one review before configuration moved forward. Testing discipline Built practical scenarios across testing stages, with evidence that helped teams resolve defects and approve releases. Payer communication Explained technical benefit impacts in plain language, earning confidence during renewals, migrations, and production support. SKILLS Facets Configuration Benefit Design Claims Adjudication SQL Data Analysis Requirements Analysis Solution Design User Acceptance Testing Root Cause Analysis Product Launches Benefit Renewals Migrations Agile Delivery Compliance Controls Stakeholder Management LANGUAGES English Native 40 Spanish Beginner 10 MY CAREER 9 Years Senior Facets Product & Benefits Analyst at NorthStar Payer Solutions (3.7 Years) Facets Configuration Analyst at Great Lakes Health Plan Services (2.4 Years) Healthcare Benefits Configuration Specialist at PrairieCare Benefit Administrators (2 Years) Claims and Benefits Analyst at Midwest Member Health Cooperative (11 Months) SUMMARY Senior healthcare payer analyst with nine years of experience across Facets Product & Benefits configuration, benefit design, claims operations, product implementation, testing, and production support. Brings more than six years of hands on Facets experience across Commercial, Medicare Advantage, Medicaid, Exchange, and ASO products. Translates business, operational, regulatory, and product requirements into accurate benefit configurations covering copays, coinsurance, deductibles, accumulators, out of pocket maximums , coverage tiers, limits, exclusions, cost sharing, and network rules. Leads solution reviews, cross functional workshops, testing, defect resolution, migrations, renewals, product launches, release readiness, and stabilization. Uses SQL, data analysis, configuration comparison, and root cause analysis to connect claims outcomes with eligibility, membership, pricing, provider networks, interfaces, and downstream systems. Ready to contribute practical payer insight, clear communication, and dependable configuration delivery. EXPERIENCE Senior Facets Product & Benefits Analyst NorthStar Payer Solutions January 2023 - Present Minneapolis, MN Owns Facets Product & Benefits delivery for Commercial, Medicare Advantage, and ASO offerings. Leads solution design , configuration governance, testing, release readiness, production stabilization, and analyst mentoring across payer operations. Translated product designs into Facets cost sharing , accumulators, limits, exclusions, tiers, and network rules . Led solution reviews with claims, pricing, eligibility, membership, networks, compliance, QA, and technology partners. Directed unit, system, integration, regression, and user acceptance testing through claims adjudication validation. Used SQL and configuration comparisons to isolate claim discrepancies and document sustainable corrective actions. Coordinated renewals, launches, release readiness , migrations, and stabilization with audit ready decision records. Mentored analysts on Facets configuration, defect triage, testing discipline, and cross system impact analysis Facets Configuration Analyst Great Lakes Health Plan Services July 2020 - December 2022 Madison, WI Supported Facets configuration and implementation for Medicaid, Exchange, and Commercial plans. Connected benefit changes with claims, eligibility, pricing, provider networks , interfaces, batch processes, testing, and release controls. Configured Medicaid, Exchange, and Commercial benefits from approved specifications and plan documents. Analyzed downstream effects across eligibility , membership , networks, pricing, batch processes, and interfaces. Built unit, system, integration, regression, and user acceptance scenarios with reproducible evidence. Compared legacy and target configurations during product migration, reconciling benefit differences for phased releases. Performed SQL checks and root cause analysis across configuration, eligibility, pricing , provider, and interface conditions. Maintained configuration documentation, compliance controls , release artifacts, and audit ready evidence Healthcare Benefits Configuration Specialist PrairieCare Benefit Administrators June 2018 - June 2020 Des Moines, IA Maintained Commercial and ASO benefit configurations while supporting Facets changes, annual renewals, claims validation, testing, issue investigation, and traceable implementation documentation for payer stakeholders. Maintained Commercial and ASO copay, coinsurance , deductible, accumulator, limit, and exclusion configurations. Implemented Facets changes and verified network variations against intended claims adjudication results. Prepared regression and user acceptance cases, reconciled claim outputs, and documented exceptions. Investigated benefit inquiries through Facets configuration and claims history, escalating evidence based defects. Supported annual renewals by inventorying changes, validating updates, and coordinating stakeholder status. Organized implementation records and control evidence from approved requirements through tested production changes Claims and Benefits Analyst Midwest Member Health Cooperative June 2017 - May 2018 Omaha, NE Analyzed Commercial claims and member benefit inquiries, building foundational payer expertise across eligibility, networks, pricing, cost sharing, adjudication, testing, documentation, and cross functional issue resolution. Analyzed Commercial claims and member inquiries across eligibility, networks, pricing, and cost sharing . Researched claim outcomes against plan documents and system benefit records for accurate escalation. Produced issue summaries with claim context, expected behavior, member impact, and system evidence. Used spreadsheet reconciliations and introductory SQL queries to identify recurring claim patterns. Prepared representative claim scenarios for user acceptance testing and recorded results for review. Maintained case documentation and audit trails while coordinating updates across claims and member services PROJECTS Facets Product Migration December 2022 Compared legacy and target benefit configurations for a phased payer migration. Reconciled coverage differences, tested representative claims, documented dependencies, and prepared validated release packages for stakeholders. Medicare Advantage Benefit Renewal September 2025 Coordinated annual benefit renewal updates across Facets, claims, pricing, eligibility, and networks. Validated cost sharing, accumulators, limits, exclusions, and production outcomes before release. LEADERSHIP & AWARDS Recognized by payer leadership for dependable Facets configuration delivery and clear production issue analysis. Selected to mentor analysts on benefit testing, defect triage, configuration comparison, and cross system impact review. Received team recognition for maintaining audit ready release evidence during migrations and annual renewals. EDUCATION Bachelor of Science in Health Information Management University of Nebraska at Omaha GPA: 4.0 2017 Omaha, NE Coursework: Healthcare administration, health information systems, healthcare data analysis, claims processing CERTIFICATIONS AHIP Medicare Training 2026 Facets Product & Benefits Advanced Configuration Certificate 2024 TECHNICAL SKILLS Facets Product Configuration: Facets Product & Benefits, benefit rules, accumulators Benefit Design: Copays, coinsurance, deductibles Cost Sharing: Out of pocket maximums, coverage tiers, limits Payer Products: Commercial, Medicare Advantage, Medicaid Exchange and ASO: Exchange plans, ASO products, network variations Testing Methods: Unit testing, system testing, integration testing Release Testing: Regression testing, user acceptance testing, production validation Data Analysis: SQL, spreadsheet reconciliation, claims data analysis Configuration Tools: Configuration comparison, Facets batch, Facets interfaces Claims Operations: Claims adjudication, defect triage, production support Delivery Methods: Agile delivery, solution design, requirements analysis Governance and Controls: Compliance controls, audit evidence, release documentation SKILLS Facets Configuration Benefit Design Claims Adjudication SQL Data Analysis Requirements Analysis Solution Design User Acceptance Testing Root Cause Analysis Product Launches Benefit Renewals Migrations Agile Delivery Compliance Controls Stakeholder Management PROFESSIONAL AFFILIATIONS AHIP professional learning community participant, with ongoing focus on Medicare policy and payer operations. Healthcare information management professional network member, sharing practical insight on data quality and claims administration. LANGUAGES English (Native) Spanish (Beginner) ADDITIONAL INFORMATION Work Status : Authorized to work in United States. No sponsorship required. ADDITIONAL INFORMATION Work Status : Authorized to work in United States. No sponsorship required. REFERENCES AVAILABLE ON REQUEST

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