Job Description

Job Title: HealthRules Payor Configuration Analyst
Location: Remote USA
6+ months

Client: Healthcare

8+ yrs needed

Job Summary:

We are seeking a detail-oriented and experienced HealthRules Payor Configuration Analyst to support configuration and maintenance of benefit plans, provider contracts, and pricing rules within the HealthRules Payor (HRP) platform. The ideal candidate will have hands-on experience in configuring HRP, a strong understanding of healthcare payer operations, and the ability to collaborate cross-functionally in a remote work environment.

Key Responsibilities:

• Design, build, test, and maintain configuration within the HealthRules Payor system for benefit plans, provider contracts, pricing rules, and claims adjudication logic.
• Interpret business requirements and convert them into effective configuration solutions.
• Perform impact analysis of configuration changes and troubleshoot issues related to claims processing and benefits administration.
• Collaborate with business, IT, and QA teams to ensure timely delivery of configuration updates and enhancements.
• Develop and execute configuration test cases; participate in UAT and production validation.
• Ensure compliance with regulatory requirements and support internal/external audits related to configuration.
• Document configuration decisions and maintain up-to-date records for knowledge management and process improvement.

Required Qualifications:

• 3+ years of hands-on experience with HealthRules Payor configuration (benefit plans, pricing, provider contracts, etc.).
• Strong understanding of healthcare payer operations , including claims adjudication, benefits administration, and provider reimbursement.
• Ability to analyze complex business requirements and translate them into technical configuration.
• Experience with healthcare data standards (e.g., EDI, HIPAA 837/835).
• Experience with test planning, execution, and defect resolution.
• Strong analytical, problem-solving, and organizational skills.
• Excellent verbal and written communication skills.
• Ability to work independently in a remote, fast-paced environment.

Job Tags

Similar Jobs