Your mission?

We are seeking an experienced Healthcare Claims Platform Configuration SME with strong expertise in U.S. healthcare payer claims platforms such as HealthRules Payor, Facets, QNXT, WebTPA/TPA, or equivalent systems. You will configure healthcare perks and claims adjudication rules, translate business requirements into platform configurations, and support migration, testing, cutover, and production stabilization.

■■ STACK

→ HealthRules Payor / HealthEdge

→ Facets / QNXT / WebTPA / TPA Platforms

→ Healthcare Claims Adjudication

→ Benefits Configuration

→ Provider Pricing & Reimbursement

→ SQL / Data Analysis

■ CORE PROTOCOLS

01 // CONFIGURE WITH PRECISION — Build and validate complex benefits, claims adjudication, provider pricing, and reimbursement configurations to ensure accurate healthcare claim outcomes.

02 // RESOLVE AT THE ROOT — Analyze suspended, denied, incorrectly paid, and manually processed claims to identify configuration issues and improve auto-adjudication.

03 // DELIVER WITH CONFIDENCE — Support configuration migration, UAT, production cutover, claims reprocessing, remediation, and stabilization across environments.

📌 Healthcare Claims Platform Configuration SME (Hyderabad)
🏢 Allshore Technologies
📍 Hyderabad