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
→ Advantages 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 settings.