Configuration Analyst

Gold Coast Health Plan; California; Remote; USD 100,000 - 150,000; Full time

Job summary

Gold Coast Health Plan seeks a configuration analyst to translate business needs into HRP setups for benefits, pricing, and provider contracts. You will design benefit structures, copay rules, and EOC mappings while coding provider reimbursement logic and VB rules.

Responsibilities include test planning, UAT execution, impact analysis, and production validation, with attention to California regulatory updates. Collaboration across Operations, Network and Compliance is essential.

Qualifications

• High School graduate or GED required with healthcare configuration experience.
• 2–5 years configuring HRP across benefits, provider contracts, pricing rules and edits.
• California health plan experience; Medi‑Cal preferred.
• Ability to translate requirements into accurate configuration with rationale.
• Strong testing, impact analysis, and production validation skills.
• Excellent written and oral communication, able to work independently.

Responsibilities

• Translate business requirements into HRP configuration across benefits, pricing rules, accumulators, and edits.
• Build and maintain benefit structures, coverage tiers, copays, and EOC mappings.
• Configure provider reimbursement logic: fee schedules, capitation, FFS, VB rules.
• Apply HRP tools to model complex logic without custom code.
• Develop test scenarios and perform UAT; support validation and defect remediation.
• Ensure configuration aligns with California regulations and policy updates.
• Collaborate with Operations, Network, Product, Compliance, and QA.
• Document decisions, validation results, and governance artifacts.

Skills

HRP

HealthRules Language

Designer/Manager

EDI experience

Regulatory knowledge

Communication skills

Education

GED/High School

Bachelor’s degree

Tools

Answers/Connector

Health Rules

Job description

Come Grow With UsAt 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.Working at Gold Coast Health Plan means working alongside a team of committed individuals who are reshaping the organization and redefining how the needs of the whole person – health, health care, and social services and supports – are met. We are seeking collaborators, innovators, and those who are driven to be their very best.If you are looking for a career of purpose and are passionate about having an impact on society’s health care challenges, then Gold Coast Health Plan is where you should be. Here, you will be challenged and rewarded in equal measure.About this role:Reasonable Accommodations StatementTo accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.**This role is open to California residents only.**ESSENTIAL FUNCTIONSJob Function & Responsibilities·Configuration Design & Buildo Translate business requirements into accurate HRP configuration across benefits, provider contracts, pricing rules, accumulators, claims edits, and product variations.o Build and maintain benefit structures, benefit dictionaries, coverage tiers, copays, deductibles, and EOC/Evidence of Coverage mappings.o Configure provider reimbursement logic including fee schedules, capitation, FFS, value‑based rules, and DOFR constructs.o Apply HRP tools (HealthRules Language, Designer/Manager) to model complex logic without custom code.·Testing & Validationo Develop detailed test scenarios and execute UAT for configuration changes, ensuring financial and non‑financial accuracy.o Perform impact analysis for new configuration, regulatory updates, and system enhancements.o Support production validation, post‑release monitoring, and defect remediation with clear traceability to requirements.·Troubleshooting & Root‑Cause Analysiso Investigate adjudication issues, benefit discrepancies, and pricing errors using structured analysis.o Identify root causes across configuration, requirements, provider contracts, and system logic.o Document findings and collaborate with cross‑functional teams to implement corrective actions.·Regulatory & Compliance Alignmento Ensure configuration adheres to California regulatory requirements, including Medi‑Cal benefit structures, payment rules, and policy updates.o Maintain awareness of state and federal regulatory changes and assess configuration impacts.·Cross‑Functional Collaborationo Partner with Operations, Network, Product, Compliance, and QA to ensure configuration aligns with business goals and regulatory needs.o Participate in requirements sessions, benefit design reviews, contract updates, and system enhancement planning.o Provide subject‑matter expertise during audits, regulatory reviews, and cross‑departmental initiatives.·Documentation & Governanceo Maintain clear documentation of configuration decisions, logic, test cases, and validation results.o Support configuration governance processes, including standards, naming conventions, and version control.o Contribute to playbooks, SOPs, and best practices for configuration quality and release readiness.· Continuous Improvemento Identify opportunities to streamline configuration processes and reduce defects.o Support HRP upgrades, parallel testing, cutover readiness, and post‑go‑live stabilization activities.o Mentor junior analysts and contribute to team knowledge development. Any other duties assignedMINIMUM QUALIFICATIONSEducation & Experience:· 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).· Demonstrated ability to translate complex business requirements into accurate configuration with documented rationale.· Strong 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.KNOWLEDGE, SKILLS & ABILITIESPreferred Qualifications:· Bachelor’s degree· Three plus years’ experience with Medi-Cal guidelines· Three plus years’ experience data analytics and reporting· Two years’ experience in a Supervisor, Lead, Trainer, Quality Assurance or Auditor role· Three years’ experience using analytical thinking skills and demonstrated ability to exercise sound judgment when making decisions· Experience with Medi‑Cal managed care contract constructs and operational requirements.· Exposure to broader HRP functional areas (enrollment, billing, provider, finance, medical management/GuidingCare).· Experience with HRP implementations, conversions, or major upgrade cycles.· Familiarity with configuration governance frameworks and release management processes.Technology & Software Skills: Advanced computer skills in MS Office products.Certifications & Licenses: NoneCompetency Statements· Business Acumen - Ability to grasp and understand business concepts and issues.· Communication, Oral - Ability to communicate effectively with others using the spoken word.· Communication, Written - Ability to communicate in writing clearly and concisely.· Research Skills - Ability to design and conduct a systematic, objective, and critical investigation.· Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.The estimated pay range for the position is:$100,000.00 - $150,000.00The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.700