Senior HRP Benefits Configuration Consultant

Remote role with a start date of ASAP and an end date of January 30, 2027 (potential extensions). Occasional on-site work may be required during Go Live (approximately 2 weeks).

About the role

The ideal candidate will possess deep expertise in HealthRules Payor Benefits Configuration, Medicare and Medicaid benefit design, claims adjudication, pricing, testing, and production support. This individual will work closely with Business Operations, Product, Claims, Configuration, IT, QA, and HealthEdge to configure and implement complex healthcare benefit plans while ensuring regulatory compliance and high auto-adjudication performance. The successful candidate is a self-driven consultant capable of translating business requirements into HealthRules Payor configuration while supporting implementation, testing, and production stabilization.

Responsibilities

• HealthRules Payor Benefits Configuration
  • Configure and maintain medical benefit plans within HealthRules Payor (HRP), including:
    • Benefit Packages/Products
    • Plan Designs/Cost Shares
    • Deductibles/Copays
    • Coinsurance/Accumulators
    • Limits/Exclusions
  • Configure pricing and benefit logic to support accurate claims adjudication.
  • Support benefit changes resulting from CMS and State regulatory updates.
• Business Analysis
  • Collaborate with Business and IT stakeholders to understand benefit requirements.
  • Translate business requirements into technical configuration specifications.
  • Identify configuration gaps and recommend solutions.
  • Participate in requirements gathering sessions and design reviews.
• Testing
  • Develop test scenarios.
  • Execute configuration validation.
  • Support SIT, UAT, End-to-End, and Production Validation.
  • Validate benefit configuration before deployment.
  • Support defect triage and issue resolution.
• Production Support
  • Investigate production incidents.
  • Perform root cause analysis.
  • Coordinate configuration fixes.
  • Support implementation weekends and Go-Live activities.
  • Participate in Command Center activities during stabilization.

Qualifications

• 7+ years of Healthcare Payer experience.
• 5+ years of HealthRules Payor (HRP) Configuration experience.
• Strong expertise configuring:
  • Medical Benefits/Products
  • Plans/Pricing
  • Cost Sharing
• Experience with:
  • Medicare Advantage
  • Medicaid
  • Dual Eligible (D-SNP)
  • Commercial Health Plans
• Strong understanding of:
  • Claims adjudication
  • Benefit administration
  • CMS regulations
  • Benefit interpretation
• Experience supporting HRP implementations or migrations.
• Strong analytical and troubleshooting skills.
• Excellent communication skills.
• Ability to work directly with executive leadership, business users, and technical teams.

Preferred Qualifications

• Medicare Advantage implementation experience.
• Medicaid implementation experience.
• D-SNP configuration experience.
• Benefit migrations experience.
• Health plan system conversions experience.
• Claims optimization experience.
• Production stabilization experience.
• Go-Live Command Centers experience.
• CMS Annual Benefit Updates experience.

Skills

• Strong client-facing communication.
• Ability to translate business needs into technical solutions.
• Excellent documentation skills.
• Strong problem-solving ability.
• Organized and detail-oriented.
• Ability to manage multiple priorities.
• Collaborative leadership and peer review.