Job description:
Primary Responsibilities
Lead HealthRules configuration activities for commercial group products, including:
o Benefits configuration
o Pricing and accumulator logic
o Provider contracts
o Claims processing rules
Triage, prioritize, and manage the configuration backlog, including:
o Production defects
o Enhancement requests
o Annual readiness and renewal activities
Act as the primary intake point for configuration work from business owners and operations teams
Coordinate configuration handoffs and testing support with the offshore QA team
Provide technical guidance, oversight, and configuration code review for configuration analysts
Ensure configuration aligns with approved business requirements and testing standards
Deliver weekly status reporting to Client
Support operational stability
Operate in a ~20% supervisory / lead capacity, with the remainder in hands-on configuration and analysis
Required Skills & Experience
7+ years of hands-on HealthRules Payer configuration experience
3+ years supporting commercial group health plan configuration, including:
o Deductibles
o Out-of-pocket maximums
o Accumulators
o Tiered benefit designs
Expert-level proficiency with:
o HealthRules Designer
o HealthRules Manager
o HealthRules Language (HRL)
Demonstrated experience acting as a configuration lead or technical lead on HealthRules projects
Strong understanding of end-to-end claims processing and benefits configuration
Strong communication skills with ability to:
o Partner with business stakeholders
o Explain technical configuration decisions clearly
Preferred Qualifications
Experience with provider network configuration and pricing schedules
Prior experience working in a staff augmentation or managed services delivery model
Experience supporting annual benefit renewals and readiness cycles
Experience working with offshore QA or testing teams
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