Crea Services

HealthRules Configuration

Sacramento, CA

Job description:

Primary Responsibilities

• Lead HealthRules configuration activities for commercial group products, including:
• Benefits configuration
• Pricing and accumulator logic
• Provider contracts
• Claims processing rules
• Triage, prioritize, and manage the configuration backlog, including:
• Production defects
• Enhancement requests
• Annual readiness and renewal activities
• Act as the primary intake point for configuration work from business owners and operations teams
• Coordinate configuration handoffs and testing support with the offshore QA team
• Provide technical guidance, oversight, and configuration code review for configuration analysts
• Ensure configuration aligns with approved business requirements and testing standards
• Deliver weekly status reporting to Client
• Support operational stability
• Operate in a ~20% supervisory / lead capacity, with the remainder in handson configuration and analysis

Required Skills & Experience

• 7+ years of handson HealthRules Payer configuration experience
• 3+ years supporting commercial group health plan configuration, including:
• Deductibles
• Outofpocket maximums
• Accumulators
• Tiered benefit designs
• Expertlevel proficiency with:
• HealthRules Designer
• HealthRules Manager
• HealthRules Language (HRL)
• Demonstrated experience acting as a configuration lead or technical lead on HealthRules projects
• Strong understanding of endtoend claims processing and benefits configuration
• Strong communication skills with ability to:
• Partner with business stakeholders
• Explain technical configuration decisions clearly