Healthcare Configuration Architect

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

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.