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Now viewing: Healthrules Payer Sme
TC
Tata Consultancy Services Limited
Healthrules Payer Sme
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Job Description
HealthRules Payer SME
Location
: Canton, MA
Experience
: 10 - 20 Years
Apply By
: 21st December 2026
Job Description
Must-Have Technical/Functional Skills
l Serve as the functional and technical subject-matter expert for the payer platform, providing expertise
in claims adjudication, benefits, pricing, enrollment, provider, and member processing.
l Analyze and resolve complex claims-processing issues, including claims stuck in workflow,
adjudication exceptions, reprocessing failures, and validation errors.
l Optimize payer-platform payment-cycle operations to improve claims-payment accuracy and enable
timely issue identification and resolution.
l Possess a good understanding of the configuration and validation of payer-platform business rules,
including benefits, reimbursement methodologies, provider contracts, pricing logic, and claims edits.
l Partner with Claims, Provider, Enrollment, Finance, and Compliance teams to translate business
requirements into payer-platform solutions and process improvements.
l Support payer-platform integrations and interfaces, including EDI transactions, downstream systems,
payment-integrity platforms, and external vendor solutions.
l Lead root-cause analysis and incident resolution for production issues, coordinating with infrastructure,
database, application, and vendor teams.
l Improve operational documentation, standard operating procedures, process flows, and knowledge
assets.
l Possess good knowledge of migrating claims adjudication from other platforms to the payer platform.
Roles & Responsibilities
l Demonstrate in-depth knowledge of payer-side healthcare operations and expertise in payer platforms.
l Collaborate with key stakeholders to translate business and technical requirements and issues into
implementable products and solutions with the necessary technical interfaces and integrations.
l Create high-level architecture and design specifications focused on system integration and alignment
with business processes.
l Partner with customers to present business and technical solutions for complex functionality and
cross-functional issues.
l Work closely with product and project teams to review and analyze requirements, identify gaps, present
operational solutions, and surface client needs to product teams.
l Lead business-transformation initiatives by aligning business-capability models with value streams.
l Integrate strategic business needs, process management, operations, and systems to deliver
comprehensive solutions
Salary Range:
$120,000-$145,000 a year
TCS Employee Benefits Summary:
Discretionary Annual Incentive.
Comprehensive Medical Coverage:
Medical & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans.
Family Support:
Maternal & Parental Leaves.
Insurance Options:
Auto & Home Insurance, Identity Theft Protection.
Convenience & Professional Growth:
Commuter Benefits & Certification & amp; Training Reimbursement.
Time Off:
Vacation, Time Off, Sick Leave & Holidays.
Legal & Financial Assistance:
Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing.
#LI-SP1
Location
Canton, MA
Function
TECHNOLOGY
Role
Process Expert
ID
437106
Skills
Healthcare
Salary Range
$120,000 - $145,000
Desired Candidate Profile
Qualifications
BACHELOR OF COMPUTER
SCIENCE
Benefits
- Sick Leave
- 401(k) Plans
- Bonuses/Stipends
- Health Insurance