HealthRules Payor Configuration Analyst

Overview

HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge.com.

You Are:

HealthEdge is searching for a highly motivated HealthRules Payer Configuration Analyst to join our team. As an HealthRules Payer Configuration Analyst, you will have expertise in multiple modules of HealthRules Payer configuration to support daily operations of an assigned client.  You will interact with the client and offshore counterparts to work tickets and meet client’s business needs.  You will manage incidents, gather requirements, configure, unit test and provide requirements to offshore for configuration.  In addition, the Configuration Analyst will validate offshore configuration activities by performing peer reviews and monitoring claim impact reports for accuracy and integrity.  As an operations team member, you will have opportunities to improve processes through automation, driving efficiency and reducing manual effort.

The Opportunity:

• Must have excellent communication skills and presentation skills including the ability to convey business requirements/configuration effectively with both the client and offshore team members
• Analyzes claim impact reports for reprocessing projects to assess financial impact, and performs quality reviews to ensure analytical accuracy and integrity
• Identifies opportunities to improve processes through automation, driving efficiency and reducing manual effort
• Must have experience in at least one module of HealthRules Payor (i.e., Benefits, Pricing, Claims, Finance, etc)
• Analyze business requirements, configure and unit test software (HealthRules Payor)
• Approach problems as challenges and deal with them constructively while promoting this approach to the organization
• Work independently and with a team to solve and test complex scenarios
• Track tickets and formulate plan to remediate any issues as needed
• Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

Qualifications:

• Strong analytical and problem-solving skills.
• 2+ years HealthRules Payer Configuration experience
• Hands on experience within Pricing and Contracts; Source and Editing experience preferred 
• Eagerness to learn and adapt to a fast-paced environment.

Skills & Competencies:

• Detail oriented
• Good communication skills
• Self-starter
• Agile Methodology Preferred

Geographic Responsibility:  Remote, US

Type of Employment: Full-time, permanent 

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:  

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.  

• Work across multiple time zones in a hybrid or remote work environment. 

• Long periods of time sitting and/or standing in front of a computer using video technology. 

• May require travel dependent on company needs. 

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.  Candidates may be required to go through a pre-employment criminal background check. 

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. 

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**The annual US base salary range for this position is $85,000 to $100,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.