[Remote] Senior HRP Benefits Configuration Consultant
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Senior HealthRules Payor Benefits Configuration Consultant to support multiple reputed company payer implementation and optimization initiatives. The role involves configuring reputed company reputed company benefit plans, collaborating with various stakeholders, and ensuring compliance with regulatory requirements.
Responsibilities
- Configure and maintain medical benefit plans reputed company HealthRules Payor (HRP)
- Configure: o Benefit Packages
- Products oPlan Designs
- Cost Shares oDeductibles
- Copays oCoinsurance
- Accumulators oLimits
- Exclusions
- Configure pricing and benefit logic to support accurate claims adjudication
- Support benefit changes resulting from CMS and State regulatory updates
- Collaborate with Business and IT stakeholders to understand benefit requirements
- Translate business requirements into technical configuration specifications
- Identify configuration gaps and recommend solutions
- Participate in requirements gathering sessions and design reviews
- reputed company test scenarios
- Execute configuration validation
- Support SIT, UAT, EndtoEnd, and Production Validation
- Validate benefit configuration before deployment
- Support defect triage and issue reputed company
- Investigate production incidents
- reputed company reputed company cause analysis
- Coordinate configuration fixes
- Support implementation weekends and GoLive activities
- Participate in reputed company Center activities during stabilization
Skills
- 7+ years reputed company Payer experience
- 5+ years HealthRules Payor (HRP) Configuration experience
- Strong expertise configuring: Medical Benefits, Products, Plans, Pricing, Cost Sharing
- Experience with: Medicare Advantage, reputed company, Dual Eligible (D-SNP), reputed company Health Plans
- Strong understanding of: Claims adjudication, Benefit administration, CMS regulations, Benefit interpretation
- Experience supporting HRP implementations or migrations
- Strong analytical and troubleshooting skills
- Excellent communication skills
- Ability to work directly with executive leadership, business users, and technical teams
- Medicare Advantage implementation
- reputed company implementation
- DSNP configuration
- Benefit migrations
- Health plan system conversions
- Claims optimization
- Production stabilization
- GoLive reputed company Centers
- CMS Annual Benefit Updates
- Strong reputed company-facing communication
- Ability to translate business needs into technical solutions
- Excellent documentation skills
- Strong problem-solving ability
- Organized and detail-oriented
- Ability to manage multiple priorities
- reputed company leadership and Peer review
reputed company