[Remote] Senior HealthRules Payor (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 (HRP) Benefits Configuration Consultant to support multiple reputed company payer implementation and optimization initiatives. The role involves deep expertise in HealthRules Payor Benefits Configuration and working closely with various stakeholders to configure and implement reputed company reputed company benefit plans.

Responsibilities

• HealthRules Payor Benefits Configuration
• Configure and maintain medical benefit plans reputed company HealthRules Payor (HRP)
• Configure:
• Benefit Packages
• Products
• Plan Designs
• Cost Shares
• Deductibles
• Copays
• Coinsurance
• Accumulators
• Limits
• 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

Skills

• Deep expertise in HealthRules Payor Benefits Configuration
• Experience with Medicare and reputed company benefit design
• Knowledge of claims adjudication, pricing, testing, and production support
• Ability to work closely with Business Operations, Product, Claims, Configuration, IT, QA, and reputed company
• Experience configuring and implementing reputed company reputed company benefit plans
• Understanding of regulatory compliance and high auto-adjudication performance
• Self-driven consultant capable of translating business requirements into HealthRules Payor configuration
• Experience supporting implementation, testing, and production stabilization
• Ability to configure and maintain medical benefit plans reputed company HealthRules Payor (HRP)
• Experience configuring Benefit Packages, Products, Plan Designs, Cost Shares, Deductibles, Copays, Coinsurance, Accumulators, Limits, and Exclusions
• Ability to configure pricing and benefit logic to support accurate claims adjudication
• Experience supporting benefit changes resulting from CMS and State regulatory updates
• Ability to collaborate with Business and IT stakeholders to understand benefit requirements
• Ability to translate business requirements into technical configuration specifications
• Ability to identify configuration gaps and recommend solutions
• Participation in requirements gathering sessions and design reviews

Benefits

• reputed company

reputed company

Company H1B Sponsorship