Senior HRP Benefits Configuration Consultant in Washington, District of Columbia at Educology Solutions

Senior HealthRules Payor (HRP) Benefits Configuration Consultant to support multiple healthcare payer implementation and optimization initiatives. The ideal candidate will possess deep expertise in HealthRules Payor Benefits Configuration, Medicare and Medicaid benefit design, claims adjudication, pricing, testing, and production support.

This individual will work closely with Business Operations, Product, Claims, Configuration, IT, QA, and HealthEdge to configure and implement complex healthcare benefit plans while ensuring regulatory compliance and high auto-adjudication performance.
The successful candidate is a self-driven consultant capable of translating business requirements into HealthRules Payor configuration while supporting implementation, testing, and production stabilization. The start date will be ASAP and end Jan 30th 2027 with potetial extensions. All work will be remote, with the possibility of being on site during Go Live (2 weeks).

DUTIES & RESPONSIBILITIES

HealthRules Payor Benefits Configuration
• Configure and maintain medical benefit plans within HealthRules Payor (HRP)
• Configure:
o Benefit Packages
o Products
o Plan Designs
o Cost Shares
o Deductibles
o Copays
o Coinsurance
o Accumulators
o Limits
o Exclusions
• Configure pricing and benefit logic to support accurate claims adjudication.
• Support benefit changes resulting from CMS and State regulatory updates.
Business Analysis
• Collaborate with Business and IT stakeholders to understand benefit requirements.
• Translate business requirements into technical configuration specifications.
• Identify configuration gaps and recommend solutions.
• Participate in requirements gathering sessions and design reviews.
Testing
• Develop test scenarios.
• Execute configuration validation.
• Support SIT, UAT, End-to-End, and Production Validation.
• Validate benefit configuration before deployment.
• Support defect triage and issue resolution.
Production Support
• Investigate production incidents.
• Perform root cause analysis.
• Coordinate configuration fixes.
• Support implementation weekends and Go-Live activities.
• Participate in Command Center activities during stabilization.

QUALIFICATIONS
• 7+ years Healthcare Payer experience.
• 5+ years HealthRules Payor (HRP) Configuration experience.
• Strong expertise configuring:
o Medical Benefits
o Products
o Plans
o Pricing
o Cost Sharing

• Experience with:
o Medicare Advantage
o Medicaid
o Dual Eligible (D-SNP)
o Commercial Health Plans

• Strong understanding of:
o Claims adjudication
o Benefit administration
o CMS regulations
o Benefit interpretation
• Experience supporting HRP implementations or migrations.
• Strong analytical and troubleshooting skills.
• Excellent communication skills.
• Ability to work directly with executive leadership, business users, and technical teams.

PREFERRED QUALIFICATIONS
Candidates with experience in:
• Medicare Advantage implementation
• Medicaid implementation
• D-SNP configuration
• Benefit migrations
• Health plan system conversions
• Claims optimization
• Production stabilization
• Go-Live Command Centers
• CMS Annual Benefit Updates
Soft Skills
• Strong client-facing communication
• Ability to translate business needs into technical solutions
• Excellent documentation skills
• Strong problem-solving ability
• Organized and detail-oriented
• Ability to manage multiple priorities
• Collaborative leadership and Peer review