HRP Migration Architect

About the role

Lead architect for the migration of a healthcare payer's core claims platform from a legacy claims engine to HealthEdge HealthRules Payer (HRP) as the target system. You own the target state architecture, migration strategy, and integration design from discovery through cutover and stabilization.

Responsibilities

• Target state architecture: Define the HRP solution architecture across Member, Product/Benefit, Provider, Claims, and financial modules, and keep it aligned with the enterprise architecture.
• Migration strategy: Design the end-to-end approach, including data migration (extract, transform, load, reconcile), cutover options (big bang vs. phased/LOB wise), parallel runs, and rollback.
• Legacy to HRP mapping: Lead gap/fit analysis and data mapping from legacy structures to HRP's data model. Resolve configuration vs. customization decisions.
• Configuration oversight: Guide benefit plan, product, pricing/fee schedule, contract, accumulator, and adjudication rule configuration in HRP.
• Integration and EDI design: Own the integration landscape around HRP: X12 transactions: 837 (P/I/D), 835, 834, 820, 270/271, 276/277, 278 Clearinghouse, enrollment, eligibility, and billing flows; Downstream feeds: finance/GL, pharmacy (PBM), UM/care management, data warehouse, reporting APIs and event/messaging patterns, plus interoperability touchpoints (e.g., CMS 0057 API dependencies).
• Data quality and reconciliation: Define migration validation, financial and claims reconciliation, and open claim/in flight transition rules.
• Testing and readiness: Shape the QE strategy (system, integration, end to end, UAT, regression, performance). Define entry/exit criteria and go live readiness.
• Governance and leadership: Act as technical authority with the client, HRP vendor, and delivery teams. Own design decisions, risk/issue management, and architecture review boards.
• Stakeholder communication: Translate technical decisions for business, operations, and executive audiences.

Qualifications

Required:

• 10+ years in healthcare payer technology, with 5+ years of hands on HRP experience
• Led at least 1‑2 full core claims migrations to HRP (not just implementation or support)
• Deep functional and technical knowledge of HRP modules: Member, Product, Provider, Claims, Financials
• Strong command of HIPAA X12 EDI and how it maps to HRP inbound/outbound processing
• Proven data migration experience at payer scale (conversion design, mapping, reconciliation, mock loads)
• Solid understanding of claims adjudication, pricing, accumulators, COB, appeals, and payment/remit processes
• Experience with integration patterns (APIs, MQ/ESB, ETL, batch vs. real time)
• Familiarity with regulatory requirements (HIPAA, CMS, state mandates)
• Strong executive level communication and client facing leadership
• Education: Bachelor's degree in computer science or similar field

Preferred:

• HealthEdge certifications or direct HealthEdge partner/vendor experience
• Experience with multiple LOBs (Commercial, Medicare Advantage, Medicaid, Exchange)
• Exposure to cloud hosted HRP deployments and DevOps/CI CD for configuration promotion
• Experience applying AI/automation to migration testing, mapping, or reconciliation
• Background in payer mergers or multi entity platform consolidations