Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. 

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

Under the direction of the Manager of HealthRules Payor (HRP) Configuration, the Sr Configuration Analyst for HRP Configuration will provide deep analytical and consultative support in one or more functional areas of expertise to ensure the optimal configuration and on-going maintenance of HRP, the core claims administration platform for Point32Health. Configuration detail design documentation created by this role will serve as a guide for other internal and consulting resources on the team to achieve maximum system functionality. In addition, the Sr Analyst will play a key role in analyzing the requirements, building the system configuration components, and support the testing of the system.

Job Description

Key Responsibilities/Duties – what you will be doing (top five):

• Using an agile approach, assess requirements, research business and system impacts of requirements, define possible configuration options, configure system and support user testing.
• Collaborate with stakeholders and the Configuration Team to elicit and document clear business requirements needed for configuration in Health Rules Payor
• Support integration and business process activities that utilize configuration as part of the end-to-end solution to meet business requirements
• Provide analysis and documentation that supports configuration management, design, requirements training, traceability, and audits
• Create detailed configuration design documentation that will be used by other configuration analysts to build out business rules in the system to meet business requirements
• Collaborate with cross functional areas to understand configuration inter-dependencies
• Triage possible issues identified and implement applicable remediation and testing to address confirmed configuration issues
• Provide analysis and support as needed for integration points with HealthRules Payor needed for the successful end- to-end design
• Provide support to deployment and release activities to migrate configuration to testing and production environments.
• Other projects and duties as assigned.

Qualifications – what you need to perform the job

Certification and Licensure

• Certification in medical coding is a plus.

Education

• Required: Bachelor’s degree in a related field
• Preferred: Master’s degree

Experience

• Required: 5-7 years of professional experience
• Preferred: 5-7 years minimum experience in Health Insurance or delivery with a working knowledge in one or more operational areas including Claims processing, Provider Credentialing & Reimbursement, Product & Benefit Design, Enrollment, or Medical Code sets.
• Experience in system configuration is required with the ability to analyze requirements, assess impacts, and provide design solution to implement business requirements.
• Experience in a data management and/or analytic environment with the ability to gather, document, test and implement complex business requirements.

Skill Requirements

• Knowledge and experience in one or more functional areas managed through HealthRules Payor
• Must have the analytical skills necessary to understand current data structure and operational processes to identify opportunities for improvement, as well as be able to suggest ways to address functional the gaps
• Problem solving based on understanding of system capabilities and business need
• Broad system functional knowledge to be able to conduct an impact analysis
• Business process knowledge
• Requirement elicitation
• Effective writing skills for documentation of requirements and system design documents
• Resource management skills
• Able to work collaboratively across teams

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Compensation & Total Rewards Overview

We welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org