Configuration Specialist (HRP)- REMOTE

Job Summary 

We are seeking an experienced Configuration Specialist to support ongoing production support, maintenance, enhancement, and configuration activities within its claims administration environment. This individual will serve as a hands-on resource responsible for managing configuration requests, resolving production issues, addressing backlog items, and supporting day-to-day operational needs.

The ideal candidate will possess deep experience with HealthEdge HealthRules Payer (HRP) and HealthEdge Source Pricer, with the ability to troubleshoot, analyze, and implement configuration changes in a complex payer environment.

   
Primary Responsibilities 

• Perform hands-on configuration and maintenance activities within HealthRules Payer (HRP).
• Support daily production tickets, service requests, issue resolution, and backlog management.
• Analyze business requirements and translate them into system configuration changes.
• Configure and maintain benefit plans, provider reimbursement rules, claim adjudication logic, pricing methodologies, and related payer functionality.
• Utilize HealthEdge Source Pricer to support pricing and reimbursement configurations.
• Troubleshoot production issues and perform root cause analysis.
• Collaborate with business, operations, claims, configuration, and testing teams to ensure successful implementation of changes.
• Support system enhancements, upgrades, and releases.
• Participate in configuration reviews and documentation activities.
• Assist with production validation and post-deployment support.

• 3+ years of hands-on HealthRules Payer (HRP) configuration experience.
• Experience working with HealthEdge Source Pricer.
• Strong understanding of healthcare payer operations and claims adjudication.
• Experience supporting production environments, ticket management, issue resolution, and backlog remediation.
• Knowledge of benefit configuration, claims processing workflows, provider reimbursement, and pricing methodologies.
• Ability to analyze complex business requirements and troubleshoot system issues.
• Strong communication and collaboration skills.
• Experience with PowerStepp.
• Experience supporting legacy claims administration systems.
• Knowledge of provider configuration, reimbursement methodologies, and payment integrity concepts.
• Previous experience working within a managed care, Medicare, Medicaid, or commercial health plan environment.