HealthRules Payor (HRP) Configuration Analyst (100% Remote)

DMS Vision • Frisco, TX

2d • Remote

About The Position

The HRP Configurations Analyst ensures the integrity of health plan claims processing by reviewing, analyzing, and configuring health plans’ core system platforms. The analyst obtains and analyzes the internal workflows, setup, and design of software applications to ensure the core claims system is configured in accordance with legal plan documents and regulatory requirements.

The role involves understanding system capabilities, assessing requirements, designing and validating configurations, and producing documentation that supports configuration management, requirements traceability, and audit controls. It also contributes to workflow and business-process improvements intended to improve customer service, decrease operational costs, and improve overall quality.

Requirements

• At least 5 years of experience in HealthRules Payor healthcare claims system design and configuration.
• Experience building benefit plans in HealthRules Payor.
• Claims processing knowledge and knowledge of benefit and claims configuration for claims and enrollment systems.
• Ability to contribute to process improvement projects.
• Excellent analytical, organizational, and problem-solving skills.
• Knowledge of audit processes and system controls.

Responsibilities

• Consult with users to identify current operating procedures and clarify program objectives.
• Create documentation describing program development, benefit logic, medical coding, work instructions, and corrections.
• Interpret user manuals that describe operating procedures.
• Review system components and validate that core claims system configuration aligns with plan documents and regulatory requirements.
• Develop a deep understanding of system capabilities and evaluate requirements to determine configuration design.
• Provide analysis and documentation supporting configuration management, design, requirements traceability, and audit controls needed to meet state and federal regulatory requirements.
• Develop and improve workflows and business processes to improve customer service, decrease operational costs, and improve overall quality.

What This Job Offers

• Education Level: No Education Listed