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Healthrules Payor Jobs (NOW HIRING)

TNT Staffing

QA Backend Tester

Manhattan, NY · On-site

... Facets to HealthRules Payor (HealthEdge HRP) . Key Responsibilities * Perform backend and data testing , ensuring accuracy and integrity of healthcare data * Validate data migrations and ...

HealthEdge

Quality Auditor

$35K - $48K/yr

HealthRules Payor or Guiding Care exp preferred * Ability to analyze contractual SLAs and KPIs * Ability to effectively communicate and collaborate with a remote team Geographic Responsibility:

HealthEdge

Quality Auditor

$35K - $48K/yr

HealthRules Payor or Guiding Care exp preferred * Ability to analyze contractual SLAs and KPIs * Ability to effectively communicate and collaborate with a remote team Geographic Responsibility:

Elite Technical

Claims Adjuster

Baltimore, MD · On-site

... payor) claims and ensure that claims are handled properly within authority limits, and in line with ... System (ITS) Claims - Healthrules application - LuminX Claims application - BlueSquare ...

MJHS Health System

Enrollment Coordinator

Manhattan, NY · On-site

... HealthRules Health Rules Payor in accordance to department guildelines. -Completes enrollment acceptance or deferral calls according to specified deadlines and ensures to document accordingly in MP ...

MJHS

Enrollment Coordinator

Manhattan, NY · On-site

$35K - $43K/yr

... HealthRules Health Rules Payor in accordance to department guildelines. -Completes enrollment acceptance or deferral calls according to specified deadlines and ensures to document accordingly in MP ...

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How much do healthrules payor jobs pay per hour?

As of Jul 2, 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 are the key skills and qualifications needed to thrive as a HealthRules Payor specialist, and why are they important?

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.

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.
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Healthrules Payor jobs near you
Infographic showing various Healthrules Payor job openings in the United States as of June 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $39,247 per year, or $18.9 per hour.

Healthedge/ Healthrules Configuration Consultant

RELQ TECHNOLOGIES LLC

Exton, PA • Remote

Other

Posted 9 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.