Title :

HealthRules Payer Technical Configuration & Automation Engineer /

Specialist Location :

Philadelphia , PA onsite

Job Summary :

We are seeking a HealthRules Payer Technical Configuration & Automation Engineer/Specialist to own hands-on configuration, troubleshooting, and automation across the HealthRules Payer platform. This role bridges deep technical configuration expertise with payer domain knowledge — spanning claims adjudication, Coordination of Benefits (COB), Home & Host/Blue Card processing, and ITS ecosystem workflows — while building automation frameworks that improve testing, validation, reconciliation, and operational efficiency. The ideal candidate combines the precision of a configuration analyst with the mindset of an automation engineer. Key Responsibilities Design, build, and maintain HealthRules Payer configuration across products, benefits, contracts, and business rules. Develop and modify custom logic using HealthRules Language (HRL) to support complex business and adjudication requirements. Configure and troubleshoot COB rules, edits, and primacy logic to ensure accurate primary/secondary claim processing. Support Home & Host and Blue Card/ITS configuration, ensuring correct inter-plan claim, eligibility, pricing, and financial transaction handling. Trace and resolve claims configuration and data issues, identifying root causes across benefits, elccigibility, provider, and COB logic. Build native Python automation tools for configuration validation, regression testing, reconciliation, and operational reporting. Design and execute automated test scenarios for large-scale claims testing and configuration regression coverage. Query and analyze claims, member, eligibility, configuration, and financial data using SQL to validate outcomes and support decision-making. Partner with business, QA, and integration teams to identify process gaps and recommend modernization or automation opportunities. Document configuration standards, automation frameworks, and test results to support audits, governance, and knowledge transfer. Technical Skills HealthRules Payer Configuration

• Hands-on configuration experience across products, benefits, and business rules (not limited to functional/theoretical knowledge). HealthRules Language (HRL)
• Ability to independently develop and modify rules and configuration logic using

HRL. COB

Configuration

• Hands-on experience configuring COB rules, edits, primacy-related logic, and associated claims processing. Home & Host Configuration
• Practical configuration experience with HealthRules Home/Host capabilities and cross-plan setup. Claims Configuration & Troubleshooting
• Ability to trace claim outcomes end-to-end and pinpoint configuration or data root causes. Python Automation
• Strong, demonstrable proficiency in native Python for automating configuration validation, testing, reconciliation, and operational workflows. Test Automation / Regression Testing
• Experience automating HealthRules configuration testing and large-scale claims scenario validation. API / Integration Knowledge
• Working understanding of APIs, HealthRules integration points, external system connectivity, ITS/Blue ecosystem data exchange. SQL & Data Analysis
• Ability to write and optimize queries across claims, member, eligibility, configuration, and financial data for analysis and validation. Automation Engineering Mindset
• Ability to design reusable tools/frameworks for configuration comparison, test-data generation, defect identification, reconciliation, and reporting. UiPath experience is a plus, not a requirement. Payer Domain Skills HealthRules Payer Functional Knowledge
• Strong understanding of how HealthRules supports core payer operations and business processes. COB End-to-End Knowledge
• Working knowledge of COB discovery, other coverage identification, primacy determination, primary/secondary processing, and downstream financial impact. COB Edits & Adjudication
• Understanding of how COB edits drive claim pends, denials, reprocessing, and payment outcomes. Home & Host / Blue Card / ITS Ecosystem
• Strong understanding of Home Plan vs. Host Plan operations and out-of-area member processing, including ITS Home/Host, BlueSquare, and BlueCard claim processing . Blue Card / ITS Processes
• Understanding of inter-plan claim routing, eligibility verification, pricing, adjustments, and financial settlement transactions. Claims Adjudication
• Comprehensive understanding of the claim lifecycle and how benefits, eligibility, provider contracts, and COB rules influence payment. Self-Funded Payer Business
• Understanding of financial responsibility structures and operational nuances specific to self-funded groups. Fully Funded / Fixed-Funded Products
• Understanding of product-specific business rules and the operational differences across funding arrangements. Billing & Financial Reconciliation
• Understanding of how COB and claims outcomes flow into billing, recovery, reconciliation, and financial reporting. Payer Process Analysis
• Ability to identify gaps between current-state business processes, HealthRules configuration, surrounding systems, and manual operations, and translate findings into modernization opportunities.

Qualifications Bachelor's degree in computer science, Information Systems, Healthcare or related field (or equivalent practical experience). 3+ years of hands-on Health Rules Payer configuration experience. Demonstrated experience with HRL development, COB configuration, and Home & Host/Blue Card processing. Proven Python scripting/automation experience in a production or enterprise environment. Strong SQL skills with experience querying complex healthcare data models. Experience in a health plan, payer, or healthcare IT environment strongly preferred. Familiarity with ITS/BlueCard/BlueSquare inter-plan processes strongly preferred. Soft Skills Strong analytical and root-cause problem-solving abilities. Ability to translate business/functional requirements into technical configuration and automation solutions. Clear communicator, able to work across business, QA, and technical teams. Detail-oriented with a strong sense of ownership over configuration accuracy and data integrity.

Pay:

$88,148.55

• $106,157.

39 per year

Work Location:

In person