Adjudication, Analysis Skills, Backlog Prioritization, Business Analysis, Business Operations, Claims Processing, Communication Skills, Compensation and Benefits, Configuration Management, Documentation, Health Plan, Healthcare, Identify Issues, Maintenance Services, Managed Care, Medicaid, Medicare, Pricing, Problem Solving Skills, Production Support, Production Systems, Reimbursement, Requirements Management, Root Cause Analysis, Systems Administration/Management, Team Player, Testing
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.
Education and Experience
- 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.