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Healthrules Payor Jobs (NOW HIRING)

HealthEdge Software, Inc.

Experience working HealthEdge applications like HealthRules Payor or GuidingCare is a plus * Bachelor's degree or higher in business or technical field, 12+ years of relevant work experience in ...

HealthEdge

Senior Solution Architect

Experience working HealthEdge applications like HealthRules Payor or GuidingCare is a plus * Bachelor's degree or higher in business or technical field, 12+ years of relevant work experience in ...

HealthEdge

Senior Solution Architect

Experience working HealthEdge applications like HealthRules Payor or GuidingCare is a plus * Bachelor's degree or higher in business or technical field, 12+ years of relevant work experience in ...

HealthEdge

Integration Lead

$130K - $150K/yr

Experience working HealthEdge applications like HealthRules Payor or GuidingCare is a plus Skills & Competencies: * Awareness to Agile tools and methodologies * Understanding of SQL, Core Java ...

HealthEdge

Enrollment Quality Auditor

HealthRules Payor or GuidingCare experience preferred; familiarity with EDI 834 enrollment transactions and eligibility verification systems a plus. * Ability to analyze contractual SLAs and KPIs ...

New

HealthEdge

Integration Lead

$130K - $150K/yr

Experience working HealthEdge applications like HealthRules Payor or GuidingCare is a plus Skills & Competencies: * Awareness to Agile tools and methodologies * Understanding of SQL, Core Java ...

HealthEdge Software, Inc.

$130K - $150K/yr

Experience working HealthEdge applications like HealthRules Payor or GuidingCare is a plus Skills & Competencies: * Awareness to Agile tools and methodologies * Understanding of SQL, Core Java ...

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Healthrules Payor information

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How much do healthrules payor jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for healthrules payor in the United States is $18.87, according to ZipRecruiter salary data. Most workers in this role earn between $16.35 and $20.19 per hour, depending on experience, location, and employer.

What is HealthRules Payor?

HealthRules Payor is a core administrative processing system (CAPS) used by health plans and insurance companies to manage critical business operations such as claims processing, member enrollment, and provider management. It is designed to be flexible, scalable, and configurable to meet the evolving needs of health insurers. HealthRules Payor helps organizations improve efficiency, ensure compliance with regulations, and deliver better service to members and providers. The system can integrate with other healthcare IT solutions and supports value-based care initiatives.

What are the key skills and qualifications needed to thrive as a HealthRules Payor specialist?

To thrive as a HealthRules Payor specialist, you need a solid understanding of healthcare insurance operations, business analysis, and experience with payer systems, often supported by relevant degrees or certifications in healthcare IT or business. Proficiency in HealthRules Payor software, claims processing platforms, and data analysis tools like SQL or Excel is typically required. Strong problem-solving, communication, and stakeholder management skills help specialists excel in collaborating across technical and business teams. These skills are critical for ensuring the effective configuration, implementation, and optimization of HealthRules Payor systems, which support accurate claims processing and regulatory compliance.

What are some common challenges HealthRules Payor professionals face when implementing system upgrades or new modules?

Healthrules Payor professionals often encounter challenges related to system integration, data migration, and adapting to changing regulatory requirements during upgrades or the implementation of new modules. Ensuring that existing workflows are not disrupted and that all users are properly trained on new functionalities is critical. Collaboration with IT, compliance, and business operations teams is essential to address issues quickly and maintain seamless claims processing and member management throughout the transition.

What is the difference between Healthrules Payor vs Health Insurance Underwriter?

AspectHealthrules PayorHealth Insurance Underwriter
Required CredentialsTypically requires a degree in health administration, business, or related field; certifications like CPCU or AHIP are commonRequires a degree in finance, economics, or actuarial science; professional certifications like ASA or FSA are often preferred
Work EnvironmentOffice-based, working with healthcare data, policy management, and payer systemsOffice-based, analyzing risk, reviewing policy applications, and calculating premiums
Employer & Industry UsageUsed by health insurance companies, healthcare payers, and managed care organizationsEmployed by insurance companies, reinsurance firms, and actuarial consulting firms

While both roles involve working within the health insurance industry, Healthrules Payor focuses on managing healthcare payer systems and policy administration, whereas Health Insurance Underwriters primarily assess risk and determine policy premiums. Understanding these differences helps clarify career paths and job expectations in the health insurance sector.

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Healthrules Payor jobs near you
Infographic showing various Healthrules Payor job openings in the United States as of September 2026, with employment types broken down into 84% Full Time, 8% Part Time, and 8% Contract. Highlights an 62% In-person, and 38% Remote job distribution, with an average salary of $39,247 per year, or $18.9 per hour.

Healthedge/ Healthrules Configuration Consultant

Exton, PA • Remote

RELQ TECHNOLOGIES LLC
See more jobs at RELQ TECHNOLOGIES LLCexternal

Other

Re-posted 19 days ago

Job description

Healthedge/ Healthrules Configuration QA Consultant (with HealthRules Payor (HRP) experience)

100% Remote

6+ months

Key Responsibilities:

  • Develop and execute test strategies and scripts using HealthRules Language (HRL).
  • Validate benefit configurations, plan design, and logic within the HRP platform.
  • Perform end-to-end testing of member benefits, including copays, coinsurance, accumulators, and claim adjudication logic.
  • Work with BA and config teams to interpret benefit requirement documents (BRDs) and translate them into test cases.
  • Identify configuration errors and work with cross-functional teams to resolve issues.
  • Automate benefit validation and testing using HRL and available tools.
  • Participate in test planning, defect triage, and release support activities.
  • Prepare testing documentation including traceability matrices, test data sets, and test summary reports.

Required Skills:

  • Proficiency in HRL (HealthRules Language).
  • Strong experience with HealthRules Payor (HRP) platform.
  • In-depth understanding of healthcare benefits, claims processing, and member enrollment.
  • Experience in testing benefit plan logic and configuration.
  • Ability to create and manage complex HRL scripts for validation purposes.
  • Familiarity with HIPAA standards, especially 834/837 transactions (preferred).
  • Experience with SQL for backend data validation.
  • Knowledge of Agile methodologies and tools like JIRA, Confluence, etc.