HealthRules Payor Claims Configuration Analyst

HealthTECH is recruiting a Claims Configuration Analyst with HealthRules Payor experience for an East Coast health plan. This is a direct hire role on the plan’s configuration management team.

What You’ll Do

• Configure benefit plans and build adjudication rules following established standards.
• Gather business and technical requirements alongside business analysts and translate them into configuration specifications.
• Perform configuration changes across multiple test environments and coordinate timelines with testing and project teams.
• Research and construct claims data to validate that configuration output performs as expected.
• Develop and execute unit test cases and complete Configuration Control Framework documentation for audit.
• Manage change control when results do not match expected outcomes.
• Handle the configuration promotion process across HealthRules, Optum CES, and Burgess Source.
• Serve as a resource for root cause analysis on configuration and EDI tickets.
• Maintain standard operating procedures, identify gaps between business expectations and system capability, and flag opportunities to automate manual workflows.

What You Bring

• Strongly preferred: HealthRules Payor, Optum CES (Claims Editing Software), Burgess Source, SQL query writing, JIRA experience.
• Two or more years of benefits and claims system configuration or business analysis experience in a healthcare setting
• Prior experience at a health plan, TPA, or similar payer organization
• Ability to read claims data and reason backward from an unexpected adjudication result to the configuration that caused it
• Strong documentation discipline. This role operates under audit and change control, and the paper trail matters as much as the build
• Comfort working across the organization with both business stakeholders and technical teams
• Ability to run several concurrent projects while carrying ongoing maintenance work

Position Details

• Location: Onsite near Providence, RI. Monday through Thursday with Fridays remote. Occasional additional remote days accommodated as needed, though not on a fixed recurring schedule.
• Type: Full time, direct hire. Daytime shift.

About HealthTECH Resources
HealthTECH Resources has specialized exclusively in healthcare IT for nearly 30 years. We’re a boutique firm with deep payer and provider systems expertise and long-standing health system partnerships.

HealthTECH Resources is an equal opportunity employer.