Configuration Analyst

Role overview

Configuration and testing

• Translate business requirements into HRP configuration for benefits, provider contracts, pricing rules, accumulators, claims edits, and product variations.
• Build and maintain benefit structures, coverage tiers, copays, deductibles, and Evidence of Coverage mappings.
• Configure reimbursement logic, including fee schedules, capitation, fee-for-service, value-based rules, and DOFR constructs.
• Develop and execute test scenarios and UAT; validate configuration changes and analyze impacts of updates and enhancements.

Troubleshooting and compliance

• Investigate adjudication issues, benefit discrepancies, and pricing errors; identify root causes and coordinate corrective actions.
• Ensure configuration aligns with California regulatory requirements, including Medi-Cal benefit structures, payment rules, and policy updates.
• Collaborate with Operations, Network, Product, Compliance, and QA, and provide expertise for audits and regulatory reviews.

Documentation and improvement

• Document configuration decisions, logic, test cases, and validation results; support standards, naming conventions, and version control.
• Identify process improvements, support upgrades, parallel testing, cutover readiness, and post-go-live stabilization, and mentor junior analysts.

Minimum qualifications

• High school diploma or GED.
• Two to five years of hands-on configuration experience, including at least two years with HRP across benefits, provider contracts, pricing rules, and claims edits.
• California health plan experience and strong understanding of state-specific requirements; Medi-Cal experience preferred.
• Strong understanding of payer operations, claims adjudication, reimbursement methodologies, and regulatory constructs.

Technical qualifications

• Proficiency with HealthRules Language and Designer/Manager; Answers/Connector experience is a plus.
• Experience with healthcare EDI and code sets, including HIPAA 837/835/834/270/271 and ICD-10, HCPCS, CPT, DRG, APC, and NDC.
• Strong skills in translating requirements into documented configurations, test planning, UAT, impact analysis, and production validation.
• Excellent communication, analytical, and documentation skills; ability to work independently.