Sr. HRP Analyst

Mandatory Skills

• Healthcare Claims Processing
• Health Rules Payer (HRP)
• EDI 837
• Blue Card
• Healthcare Domain Knowledge
• Claims Testing

Mandatory Skills Description

• 4+ years of experience in healthcare claims processing, healthcare operations, or claims testing.
• Strong hands-on knowledge of local claims processing within HealthRules Payer (HRP).
• Hands-on experience working with and validating EDI 837 files.
• Experience with Blue Card claims processing and/or strong understanding of HRP-to-TPA workflows.
• Strong understanding of healthcare claims lifecycle, adjudication, benefits, pricing, and payment workflows.
• Good knowledge of healthcare and health-plan terminology.
• Understanding of relevant medical and industry-standard codes, including CPT, HCPCS, ICD-9/ICD-10, CDT, Revenue, and DRG codes.
• Experience creating and executing functional, integration, and end-to-end claims test scenarios.
• Ability to analyze claims-processing results, identify defects and configuration issues, and work with technical and business teams through resolution.
• Experience working with business requirements and translating them into comprehensive test scenarios.
• Working knowledge of Azure DevOps or similar test/defect management tools.
• Strong communication skills and ability to collaborate with business and technical stakeholders.
• Experience with Association requirements and Blue Card mandates.
• Experience with benefits and package pricing configuration in HealthRules.
• SQL knowledge for data validation and claims analysis.
• Experience troubleshooting production issues related to claims or benefit configurations.
• Previous experience supporting healthcare system migrations, integrations, or major HRP enhancements.
• Experience working with Third-Party Administrator (TPA) integrations and workflows.