Job Description

Project Role :

Business Architect

Project Role Description :

Identify opportunities to deliver tangible business value by assessing the current state, capturing high-level requirements, and defining business solutions. Translate business needs into technology-enabled solutions and operating models. Support transformation by developing business cases and guiding implementation of key initiatives.

Must have skills :

Medicare Advantage

Good to have skills :

Electronic Medical Records (EMR), Health Insurance Operations

Minimum

5

year(s) of experience is required

Educational Qualification :

15 years full time education



Summary: As a Configuration Lead, you will identify opportunities to deliver tangible business value by assessing the current state, capturing high-level requirements, and defining business solutions in healthrules. Your typical day will involve collaborating with various stakeholders to understand their needs, analyzing existing processes, and proposing innovative solutions that align with the organization's strategic goals. You will also engage in discussions to translate business requirements into actionable technology-enabled solutions, ensuring that the initiatives you support are effectively implemented and deliver the desired outcomes. Roles & Responsibilities: -Lead the configuration of Pricing Team in HealthRules Payor. -Analyze business requirements and convert them into HRP configuration logic. -Configure fee schedules, provider contracts, pricing rules, and modifiers. -Collaborate with Product Owners, QA, and business teams throughout the SDLC. -Support UAT, testing, and post-production issue resolution. -Maintain configuration documentation and ensure regulatory compliance (e.g., CMS). -Mentor junior team members and help maintain best practices in configuration governance. Professional & Technical Skills: -4-6 years of HRP configuration experience. -Strong knowledge of payer pricing models (e.g., CMS, APC, DRG, RBRVS). -Experience with claims processing, 837/835 formats, and SQL/Excel for validation. -Strong analytical, documentation, and stakeholder communication skills. Additional Information: - The candidate should have minimum 7.5 years of experience in Medicare Advantage. - This position is based at our Chennai office. - A 15 years full time education is required.




15 years full time education