HRP Migration Architect

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HRP Migration Architect

Location: Remote (Preference for candidates located near Canton, MA)
Job Summary

STAFFXPERT LLC is seeking an HRP Migration Architect on behalf of our client in Canton, MA. This role will lead the migration of a healthcare payer's core claims platform from a legacy claims system to HealthEdge HealthRules Payer (HRP) . The ideal candidate will serve as the technical authority for solution architecture, data migration, integration design, testing strategy, and deployment readiness while partnering closely with business stakeholders, vendor teams, and delivery leadership.

Key Responsibilities

• Define and govern the target-state architecture across HRP modules, including Member, Product, Provider, Claims, and Financials.

• Lead end-to-end migration planning, including data conversion, reconciliation, cutover strategy, parallel operations, and production deployment.

• Conduct gap analysis and map legacy data structures and business processes to the HRP platform.

• Provide architectural guidance for HRP configuration, including benefit plans, pricing models, fee schedules, contracts, accumulators, and adjudication rules.

• Design and oversee enterprise integrations supporting enrollment, eligibility, claims processing, billing, finance, pharmacy, care management, reporting, and downstream systems.

• Define data quality, validation, and reconciliation frameworks to ensure accurate migration outcomes.

• Drive testing and readiness activities, including system, integration, regression, performance, and user acceptance testing.

• Serve as the primary technical liaison between business stakeholders, delivery teams, and platform vendors.

• Lead architecture reviews, risk assessments, and governance processes throughout the project lifecycle.

• Communicate solution direction, risks, and recommendations to both technical and executive audiences.

Required Qualifications

• 10+ years of experience in healthcare payer technology environments.

• 5+ years of hands-on experience with HealthEdge HealthRules Payer (HRP) .

• Proven experience leading at least one full-scale core claims migration to HRP.

• Deep expertise across HRP functional areas, including Member, Product, Provider, Claims, and Financials.

• Strong knowledge of healthcare claims processing, adjudication, pricing, accumulators, coordination of benefits (COB), appeals, and payment processes.

• Extensive experience with healthcare data migrations, data mapping, validation, and reconciliation activities.

• Strong understanding of HIPAA X12 EDI transactions and payer integration ecosystems.

• Experience designing and implementing APIs, ETL processes, messaging solutions, and real-time or batch integrations.

• Familiarity with healthcare regulatory and compliance requirements.

• Excellent client-facing communication, leadership, and stakeholder management skills.

Preferred Qualifications

• HealthEdge certifications or direct experience working with HealthEdge products and implementation teams.

• Experience supporting multiple healthcare lines of business, including Commercial, Medicare Advantage, Medicaid, and Exchange programs.

• Experience with cloud-based HRP environments.

• Familiarity with DevOps and CI/CD practices for application and configuration deployment.

• Experience leveraging automation or AI-driven solutions to support migration, testing, or reconciliation efforts.

• Background in large-scale payer transformations, platform consolidations, or merger-related system migrations.

Education

• Bachelor's degree in Computer Science, Information Technology, Healthcare Informatics, or a related field.