Configuration Analyst

Gold Coast Health Plan

. Translate business requirements into HRP configuration across benefits, provider contracts, pricing rules, accumulators, claims edits, and product variations .

Posted 10/16/2026full-timeRemote • California • United StatesJuniorMid-Level💰 $100,000 - $150,000 per yearWebsite

About the role

Key responsibilities & impact

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

What you’ll need

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