... configuration processes, and program execution. They are highly organized, analytical, and capable ... Experience with HealthRules and/or healthcare policy administration platforms. * Experience ...
... configuration processes, and program execution. They are highly organized, analytical, and capable ... Experience with HealthRules and/or healthcare policy administration platforms. * Experience ...
Healthrules Configuration Analyst information
What does a Healthrules Configuration Analyst do?
A Healthrules Configuration Analyst is responsible for configuring, maintaining, and optimizing HealthRules Payor or HealthRules CareManager systems used by health insurance companies. They analyze business requirements, implement system changes, and ensure that benefit plans, provider contracts, and other system rules are accurately reflected in the software. This role often involves collaborating with business analysts, IT teams, and end-users to support updates, troubleshoot issues, and ensure compliance with regulatory requirements. Their work helps healthcare organizations efficiently manage claims processing, member enrollment, and provider networks.
What are the key skills and qualifications needed to thrive as a Healthrules Configuration Analyst?
To thrive as a Healthrules Configuration Analyst, you need strong analytical skills, experience with health insurance operations, and a background in information systems or a related field. Proficiency with HealthEdge HealthRules Payor software, SQL, and familiarity with claims adjudication systems are typically required, along with relevant certifications like HealthEdge Certified Professional. Excellent problem-solving abilities, attention to detail, and effective communication are standout soft skills in this role. These competencies ensure accurate system configurations that support efficient claims processing and compliance with healthcare regulations.
How does a Healthrules Configuration Analyst typically collaborate with cross-functional teams during system implementations?
A Healthrules Configuration Analyst frequently works alongside project managers, business analysts, IT developers, and end-users to ensure accurate configuration of the Healthrules platform. During system implementations, they translate business requirements into system settings, conduct configuration testing, and troubleshoot issues collaboratively. This role requires strong communication skills, as analysts must explain technical details to non-technical team members and gather feedback for continuous improvement. Close teamwork is essential to ensure the configured solution aligns with organizational goals and regulatory standards.
What is the difference between Healthrules Configuration Analyst vs Healthrules Support Specialist?
| Aspect | Healthrules Configuration Analyst | Healthrules Support Specialist |
|---|---|---|
| Credentials | Typically requires certifications in healthcare IT or health information systems | Often requires similar certifications but focuses more on support and troubleshooting |
| Work Environment | Involves configuring, customizing, and optimizing Healthrules software for healthcare organizations | Provides technical support, troubleshooting, and user assistance for Healthrules users |
| Employer & Industry Usage | Used by healthcare providers, IT departments, and health IT vendors | Employed in healthcare organizations, IT support teams, and vendor support centers |
The Healthrules Configuration Analyst primarily focuses on configuring and customizing the Healthrules platform to meet organizational needs, while the Healthrules Support Specialist provides technical support and troubleshooting assistance. Both roles require healthcare IT knowledge and certifications, but their daily tasks and focus areas differ.
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Posted 27 days ago
Job description
Healthcare Policy Enablement Project Lead
Hybrid - Tues-Thurs - Philly, PA 19103
6+ Month Contract to Hire
Position Summary
The Policy Enablement Workstream Lead is responsible for leading the implementation, governance, and operational transition of medical policy enablement initiatives. This role serves as the primary liaison between business stakeholders, policy configuration teams, offshore resources, and executive leadership, ensuring alignment across workstreams while driving implementation success, operational readiness, and ongoing governance.
The ideal candidate possesses a strong understanding of healthcare payer operations, medical policy administration, policy configuration processes, and program execution. They are highly organized, analytical, and capable of managing complex implementation efforts while translating operational challenges into actionable recommendations and executive-level communications. This individual will lead policy enablement initiatives, support a critical operational transition from Accenture resources, coordinate offshore teams, and drive the successful execution of policy implementation and maintenance activities.
Key Responsibilities
Program & Workstream Leadership
- Own and manage Policy Enablement implementation plans, transition trackers, milestones, dependencies, risks, and operational readiness activities.
- Maintain workstream roadmaps, status reporting, governance documentation, and project trackers.
- Monitor project progress and proactively identify and mitigate implementation risks and operational issues.
- Drive coordination across onshore and offshore policy configuration teams to ensure consistent execution and delivery.
- Lead operational transition activities and knowledge transfer efforts associated with the October 2026 workstream transition.
Policy Governance & Configuration Management
- Support ongoing governance, maintenance, and optimization of the policy configuration inventory.
- Ensure policy documentation remains accurate, current, and compliant with organizational standards.
- Support change control processes, impact assessments, and implementation readiness activities.
- Partner with operational and technical teams to improve policy configuration management practices and workflow efficiency.
- Coordinate policy-related exceptions, issue resolution, and implementation activities across multiple stakeholders.
- Maintain documentation and tracking tools utilizing SharePoint and other enterprise collaboration platforms.
Stakeholder Engagement & Executive Communication
- Serve as a key point of contact for business leaders, operational teams, and project stakeholders.
- Facilitate cross-functional meetings, issue resolution sessions, and decision-making forums.
- Develop executive-level status reports, dashboards, presentations, and communications.
- Translate operational, technical, and implementation challenges into clear business impacts and recommendations.
- Provide regular updates to executive leadership, Sales, Account Management, and other business groups.
- Demonstrate executive presence through proactive stakeholder management and effective communication.
Analytics & Continuous Improvement
- Perform analytical reviews of claims, utilization, and policy-related data to identify trends, risks, and opportunities.
- Utilize advanced Excel capabilities to manage source documentation, reporting, and implementation tracking activities.
- Create and maintain complex spreadsheets, formulas, functions, pivot tables, and reporting dashboards.
- Develop recommendations for process improvements based on data-driven insights and stakeholder feedback.
- Support ongoing optimization and continuous improvement initiatives across policy enablement workstreams.
Required Qualifications
- 5+ years of experience in healthcare payer operations, medical policy administration, policy configuration, healthcare business analysis, project management, or related functions.
- Healthcare payer or health insurance industry experience required.
- Experience leading cross-functional projects or workstreams in a matrixed environment.
- Strong program and project management capabilities.
- Demonstrated experience coordinating onshore and offshore teams.
- Familiarity with medical policy administration and client setup workflows.
- Advanced Excel skills including pivot tables, formulas, functions, reporting, and data analysis.
- Experience developing executive-facing communications, presentations, and status reporting.
- Strong analytical and problem-solving skills with the ability to interpret claims and operational data.
- Excellent stakeholder management, collaboration, and communication skills.
- Proven ability to manage multiple priorities and drive successful outcomes in a fast-paced enterprise environment.
Preferred Qualifications
- Medical policy administration and policy configuration experience within a healthcare payer environment.
- Experience with HealthRules and/or healthcare policy administration platforms.
- Experience supporting implementation, migration, or transformation programs.
- Familiarity with governance frameworks, change management, and operational readiness planning.
- Familiarity with SharePoint for documentation management and collaboration.
- PMP, Lean Six Sigma, CBAP, or related project management/business analysis certification preferred.
- PM or Senior Business Analyst background strongly preferred