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Location: Remote (USA)
Hire Type: Contract (C2C)
Rate: Open

Position Summary

We are seeking an experienced Health Rules Configuration Analyst with strong expertise in the HealthRules Payor platform. The ideal candidate will have hands-on experience in healthcare payer benefit configuration, referral authorization setup, and strong knowledge of HealthRules Payor database structures and SQL querying.

This role requires a detail-oriented professional capable of supporting healthcare payer operations through accurate configuration, troubleshooting, and system optimization.

Required Skills & Experience

• Minimum 3+ years of hands-on experience in:
  • HealthRules Payor benefit configuration
  • Referral category configuration within HealthRules Payor
  • Authorization and benefit setup in payer systems
• Strong expertise in:
  • HealthRules Payor configuration and administration
  • Healthcare payer workflows and claims processing concepts
  • Benefit plan and authorization rule configuration
• Advanced understanding of:
  • HealthRules Payor table structures
  • Database relationships and configuration dependencies
• Ability to:
  • Write and execute SQL queries against HealthRules Payor tables
  • Analyze configuration issues and support troubleshooting activities
  • Validate system configurations and perform impact analysis

Key Responsibilities

• Configure and maintain benefits, referrals, and authorization rules in HealthRules Payor
• Support payer operations through accurate system configuration and testing
• Develop and execute SQL queries for data validation, troubleshooting, and reporting
• Analyze business requirements and translate them into system configurations
• Collaborate with business analysts, developers, QA teams, and stakeholders
• Perform configuration testing and support defect resolution
• Ensure compliance with healthcare payer policies and operational standards
• Maintain documentation for configurations, workflows, and change management

Preferred Qualifications

• Experience working with healthcare payers or managed care organizations
• Knowledge of claims adjudication and authorization workflows
• Familiarity with healthcare domains such as:
  • Benefits administration
  • Referrals and prior authorization
  • Provider and member configuration
• Strong analytical and communication skills
• Ability to work independently in a remote environment

Employment Details

• Work Location: Remote
• Employment Type: Contract (C2C)
• Compensation: Open / Negotiable based on experience