Specialized consultants who understand claims processing, benefit configuration, and healthcare data exchange
Health plan IT is uniquely complex. You’re managing regulatory timelines, benefit configurations that impact thousands of members, claims adjudication rules that must work flawlessly under high volumes, and data exchanges with hundreds of provider organizations, each implementing Epic, Cerner, or other EHRs slightly differently.
HealthTECH Resources has over 25 years of experience staffing payer IT projects. We provide analysts, configurators, developers, and architects who know Facets, QNXT, HealthRules, Epic Payer Platform, GuidingCare, and Jiva. These are consultants who’ve tuned auto-adjudication logic, built complex benefit designs, configured care management workflows, and debugged EPP payloads to meet critical release deadlines.
Services for Payer & Health Plan IT
Core Administrative Processing Systems (CAPS)
Configuration and optimization for Facets, QNXT, and HealthEdge HealthRules, the platforms that power benefit design, claims adjudication, and member management. Our analysts handle benefit builds, product configuration, claims routing, and the testing needed to ensure configurations work correctly before production.
Care Management Platforms
GuidingCare and Jiva implementation and configuration for utilization management (UM) and care management (CM) workflows. Integration with claims and pharmacy data to support risk stratification models, care plans, and automated authorization workflows.
Epic Payer Platform
Tapestry, Benefits Engine, Payer Contract Management, Triplets, and Accounts Payable configuration. EPP connectivity architects who design data exchange with major provider networks, reducing manual clinical document requests and improving care coordination.
Interoperability & Data Analytics
API/HIE engineers for payer-provider data exchange. EDI gateway configuration and troubleshooting. Data lake/warehouse design and ETL pipeline development. BI developers who build HEDIS/Stars dashboards and regulatory reporting that supports compliance and operational decision-making.
Common Payer IT Projects We Deliver
- Benefit and product builds: Complex benefit configurations across claims, authorizations, and pricing. Regression testing to catch configuration errors before they hit production and generate member complaints.
- Claims auto-adjudication tuning: Gateway configuration, routing logic, exception handling. Making sure high-volume transactions process cleanly while edge cases get handled appropriately.
- Payer-provider data exchange: EPP implementations that reduce clinical document requests. API-based connectivity with major provider networks. Eliminating fax-based workflows that create lag and errors.
- Regulatory and performance reporting: Data pipelines for HEDIS/Stars metrics. Operational dashboards for leadership. ETL processes that keep data warehouses aligned with changing regulatory requirements.
Proven Results with Health Plan Clients
End-to-End Payer Operations Support at Multiple Health Plans
We’ve placed teams across Facets, QNXT, and HealthRules implementations to improve configuration, claims adjudication, and regulatory reporting. This includes standing up API-based data exchanges and building data warehousing that supports both daily operations and Stars/HEDIS programs. Our consultants understand that payer systems don’t exist in isolation; claims data feeds care management, care management informs risk models, and risk models drive Stars performance.
Care Management Platform Deployments
GuidingCare and Jiva implementations that aligned utilization management and care management workflows with claims and pharmacy data. We’ve helped health plans build risk stratification models and automated care workflows that reduce manual touches, allowing care managers to focus on members rather than system workarounds.
Roles we staff most often
CAPS configuration and testing
Analysts for Facets, QNXT, HealthRules benefit builds, product setup, and claims configuration. QA leads who design regression testing that catches issues before production.
Integration and connectivity
EDI and API engineers for claims submission, remittance, eligibility verification. Interface specialists who handle HL7, X12, and FHIR-based exchanges with providers.
Epic Payer Platform specialists
Tapestry and Benefits Engine configuration. Contract management and Triplets expertise. Architects who design EPP connectivity strategies that scale across national provider networks.
Data and analytics
Data engineers and BI developers for payer reporting, Stars/HEDIS metrics, and operational dashboards. ETL specialists who build pipelines that survive schema changes and regulatory updates.
Care management experts
GuidingCare and Jiva implementers for authorization workflows, care plans, and analytics. People who tie UM/CM data back to claims and pharmacy for complete member context.
What You Can Expect from HealthTECH Resources
→ Shortlists aligned to your technology stack and business requirements
Our recruiters understand the differences between Facets and QNXT, between benefits configuration and claims adjudication, between care management and utilization review. We’ve placed hundreds of payer IT professionals and know the talent market.
→ Consultants who deliver clear, usable documentation
Configuration notes, test plans, and technical specifications your team can use after the engagement ends, not cryptic notes that only make sense to the person who wrote them.
Ready to Discuss Your Roadmap?
Share your next release or the quarter’s biggest challenge: benefit builds, provider connectivity, reporting backlogs, claims adjudication tuning, whatever’s slowing you down. We’ll propose specific roles, timelines, and a delivery approach tied to your CAPS platform, care management system, and EPP connectivity strategy.
Tell us:
- Platform and modules (Facets, QNXT, HealthRules, Epic Payer Platform, GuidingCare, Jiva)
- Your next major milestone or release
- Top 1-2 challenges (configuration, integration, testing, reporting, data exchange)
- Any compliance or regulatory deadlines driving your timeline