Configuration Analyst

This is a fully remote position, open to applicants in California.

📋 Description

• Convert business needs into HRP configurations covering benefits, provider contracts, pricing rules, accumulators, claims edits, and product variations.

• Develop and sustain benefit structures, benefit dictionaries, coverage tiers, copays, deductibles, and EOC/Evidence of Coverage mappings.

• Set up provider reimbursement logic, including fee schedules, capitation, FFS, value-based rules, and DOFR constructs.

• Utilize HealthRules Language™, Designer/Manager to represent intricate logic without resorting to custom coding.

• Create comprehensive test scenarios and carry out UAT for configuration modifications.

• Conduct impact assessments for new configurations, regulatory updates, and system improvements.

• Assist in production validation, post-release monitoring, and defect resolution.

• Examine adjudication concerns, benefit inconsistencies, and pricing mistakes.

• Determine root causes across configuration, requirements, provider contracts, and system logic.

• Document insights and work with cross-functional teams on corrective measures.

• Ensure configurations comply with California regulatory standards, including Medi-Cal benefit structures, payment regulations, and policy revisions.

• Collaborate with Operations, Network, Product, Compliance, and QA teams.

• Engage in requirements discussions, benefit design evaluations, contract amendments, and system enhancement strategies.

• Offer subject-matter expertise during audits, regulatory assessments, and cross-departmental projects.

• Maintain records of configuration decisions, logic, test scenarios, and validation outcomes.

• Support configuration governance, standards, naming conventions, and version management.

• Contribute to playbooks, SOPs, and configuration best practices.

• Spot opportunities to enhance processes and minimize defects.

• Assist with HRP upgrades, parallel testing, cutover readiness, and post-go-live stabilization activities.

• Mentor junior analysts and aid in the development of team knowledge.

• Carry out any additional responsibilities as assigned.

⛳️ Requirements

• High School diploma or General Education Degree (GED).

• 2–5 years of practical configuration experience, including a minimum of 2 years with HRP in benefits, provider contracts, pricing rules, and claims edits.

• Experience with California health plans and a strong grasp of state-specific requirements; Medi-Cal experience is preferred.

• Solid understanding of payer operations, claims adjudication, reimbursement methodologies, and regulatory frameworks.

• Proficiency in HRP components such as HealthRules Language™, Designer/Manager (Answers/Connector is a plus).

• Familiarity with healthcare EDI and code sets (HIPAA 837/835/834/270/271; ICD-10, HCPCS, CPT, DRG, APC, NDC).

• Ability to translate complex business needs into precise configurations with documented justifications.

• Skills in test planning, UAT execution, impact analysis, and production validation.

• Exceptional communication, analytical, and documentation capabilities.

• Capability to work both independently and collaboratively in a remote, fast-paced setting.

• Bachelor’s degree is preferred.

• Advanced computer proficiency in MS Office applications.

• Certifications & Licenses: None.

🏝️ Benefits

• Competitive salary and performance-based bonuses.

• Comprehensive health, dental, and vision insurance packages.

• Flexible working hours and remote work options.

• Opportunities for professional development and career advancement.

• Generous paid time off and holiday leave.