Configuration Analyst

Job not on LinkedIn

🔥 3 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $100k - $150k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Gold Coast Health Plan

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2011

At Gold Coast Health Plan, we are driven to create the health plan of the future - today. We are disrupting the conventions of the health care industry by creating and applying leading-edge solutions to its many challenges.

📋 Description

• Translate business requirements into HRP configuration across benefits, provider contracts, pricing rules, accumulators, claims edits, and product variations • Build and maintain benefit structures, benefit dictionaries, coverage tiers, copays, deductibles, and EOC/Evidence of Coverage mappings • Configure provider reimbursement logic including fee schedules, capitation, FFS, value-based rules, and DOFR constructs • Use HealthRules Language™, Designer/Manager to model complex logic without custom code • Develop detailed test scenarios and execute UAT for configuration changes • Perform impact analysis for new configuration, regulatory updates, and system enhancements • Support production validation, post-release monitoring, and defect remediation • Investigate adjudication issues, benefit discrepancies, and pricing errors • Identify root causes across configuration, requirements, provider contracts, and system logic • Document findings and collaborate with cross-functional teams on corrective actions • Ensure configuration adheres to California regulatory requirements, including Medi-Cal benefit structures, payment rules, and policy updates • Partner with Operations, Network, Product, Compliance, and QA • Participate in requirements sessions, benefit design reviews, contract updates, and system enhancement planning • Provide subject-matter expertise during audits, regulatory reviews, and cross-departmental initiatives • Maintain documentation of configuration decisions, logic, test cases, and validation results • Support configuration governance, standards, naming conventions, and version control • Contribute to playbooks, SOPs, and configuration best practices • Identify opportunities to streamline processes and reduce defects • Support HRP upgrades, parallel testing, cutover readiness, and post-go-live stabilization • Mentor junior analysts and contribute to team knowledge development • Perform any other duties assigned

🎯 Requirements

• High School Graduate or General Education Degree (GED) • 2–5 years of hands-on configuration experience, including at least 2 years working with HRP, across benefits, provider contracts, pricing rules, and claims edits • California health plan experience with strong understanding of state-specific requirements; Medi-Cal preferred • Strong understanding of payer operations, claims adjudication, reimbursement methodologies, and regulatory constructs • Proficiency with HRP components such as HealthRules Language™, Designer/Manager (Answers/Connector a plus) • Experience with healthcare EDI and code sets (HIPAA 837/835/834/270/271; ICD-10, HCPCS, CPT, DRG, APC, NDC) • Ability to translate complex business requirements into accurate configuration with documented rationale • Skills in test planning, UAT execution, impact analysis, and production validation • Excellent communication, analytical, and documentation skills • Ability to work independently and collaboratively in a remote, fast-paced environment • Bachelor’s degree (preferred) • Advanced computer skills in MS Office products • Certifications & Licenses: None