Facets DOFR / Capitation Consultant (Remote)

About the role

As a DOFR / Capitation Consultant, you will lead the design, configuration, and optimization of healthcare reimbursement solutions that support critical payer operations. You will collaborate with business stakeholders, operations leaders, technology teams, and client partners to deliver scalable, compliant, and high-performing Facets DOFR and Capitation solutions.

Responsibilities

• Lead the design, configuration, and implementation of Facets DOFR and Capitation solutions to meet client and business requirements.
• Partner with business, operations, and technology teams to define project objectives, requirements, and deliverables.
• Manage complex initiatives, ensuring project milestones, timelines, and quality standards are achieved.
• Provide subject matter expertise on DOFR, Capitation, and healthcare reimbursement methodologies.
• Monitor project progress, identify risks, and implement mitigation strategies to support successful delivery outcomes.
• Facilitate effective communication and collaboration among stakeholders, clients, and project teams.
• Support system optimization efforts, troubleshoot issues, and recommend enhancements that improve operational efficiency.
• Conduct project reviews and share best practices that drive continuous improvement and innovation.

Requirements

• 5+ years of experience working with Facets DOFR and Capitation modules, including Global, Secondary, and PCP Capitation.
• Extensive experience supporting healthcare payer operations across Commercial, ASO, Medicare, and Medicaid lines of business.
• Strong understanding of provider reimbursement, capitation methodologies, and Delegation of Financial Responsibility (DOFR) models.
• Advanced proficiency in SQL for data analysis, validation, and troubleshooting.
• Experience leading configuration, implementation, or enhancement projects within healthcare payer environments.
• Strong analytical and problem-solving skills with the ability to translate business needs into effective system solutions.
• Excellent verbal and written communication skills with proven experience collaborating across business and technical teams.
• Experience managing multiple priorities in a fast-paced client-facing environment.

Qualifications

• Experience with large-scale healthcare transformation, implementation, or modernization initiatives.
• Expertise in healthcare claims, benefits configuration, provider contracting, and reimbursement operations.
• Knowledge of healthcare regulatory requirements and payer industry best practices.
• Experience mentoring team members and providing guidance on Facets DOFR and Capitation functionality.
• Familiarity with Agile delivery methodologies and enterprise project governance processes.

Skills

• Strong analytical and problem-solving skills.
• Excellent verbal and written communication skills.
• Experience with large-scale healthcare transformation, implementation, or modernization initiatives.
• Expertise in healthcare claims, benefits configuration, provider contracting, and reimbursement operations.
• Knowledge of healthcare regulatory requirements and payer industry best practices.
• Experience mentoring team members and providing guidance on Facets DOFR and Capitation functionality.
• Familiarity with Agile delivery methodologies and enterprise project governance processes.

Benefits

Cognizant offers the following benefits for this position, subject to applicable eligibility requirements:

• Medical/Dental/Vision/Life Insurance
• Paid holidays plus Paid Time Off
• 401(k) plan and contributions
• Long-term/Short-term Disability
• Paid Parental Leave
• Employee Stock Purchase Plan

Pay

The annual salary for this position will be in the range of $132,000 - $150,000 depending on experience and other qualifications of the successful candidate.

Schedule

This is a remote position open to qualified applicants in the United States.