Configuration Analyst

Configuration Analyst

The HRP Configuration Analyst is responsible for the end-to-end configuration, maintenance, and testing of benefit and claims processing rules within the Health Rules Payor (HRP) platform by HealthEdge. This role serves as the technical bridge between clinical/product operations and system configuration, ensuring accurate benefit adjudication, compliant claims payment, and high-quality testing outcomes across all lines of business. This role must be performed near any CGI office - Hybrid

Your future duties and responsibilities:

• Benefit configuration. Configure and maintain benefit plans, cost-sharing structures, accumulators, and coverage rules in Health Rules Payor (HRP).
• Translate benefit plan documents (SBCs, EOBs, product grids) into accurate HRP system configuration.
• Set up and manage benefit periods, deductibles, out-of-pocket maximums, copays, coinsurance, and exclusion/limitation logic.
• Configure coordination of benefits (COB), subrogation rules, and Medicare/Medicaid crossover logic as applicable.
• Support annual benefit year rollover, plan refresh, and mid-year plan amendments
• Claims testing & validation. Design and execute end-to-end claim test scripts (professional, institutional, dental, pharmacy) to validate configuration accuracy.
• Perform regression, UAT, and production validation testing for new configurations and system upgrades.
• Identify, document, and track defects; partner with IT and HealthEdge support for resolution.
• Validate claim adjudication outcomes against expected benefit logic including repricing, edits, and remittance advice.
• Maintain test case libraries and testing documentation in support of audit and compliance requirements
• Cross-functional collaboration. Partner with product, clinical operations, finance, and compliance teams to gather configuration requirements and confirm business intent.
• Serve as a subject matter expert on HRP functionality during product launches, regulatory changes, and system enhancements.
• Participate in HealthEdge upgrade planning, release management, and production cutover activities.
• Support provider network loading, fee schedule configuration, and code table maintenance as needed
• Quality, governance & documentation. Maintain thorough configuration change documentation, version control, and audit trail records.
• Develop and follow configuration standards, SOPs, and naming conventions across the HRP environment.
• Support internal and external audits related to claims payment accuracy and benefit administration compliance.
• Monitor post-production claim runs for configuration anomalies and escalate issues appropriately

Required qualifications to be successful in this role:

• 3-5 years of hands-on HRP (HealthEdge Health Rules Payor) configuration experience.
• Strong working knowledge of medical claim adjudication logic and benefit plan structures.
• Experience with ICD-10, CPT, HCPCS, and revenue code sets.
• Proficiency in claim testing methodology (unit, regression, UAT).
• Familiarity with HIPAA 837/835 transaction standards.
• Strong analytical skills with attention to configuration detail and accuracy.
• Ability to translate complex benefit documents into system configuration requirements

Skills:

What you can expect from us:

Together, as owners, let's turn meaningful insights into action. Life at CGI is rooted in ownership, teamwork, respect and belonging. Here, you'll reach your full potential because… You are invited to be an owner from day 1 as we work together to bring our Dream to life. That's why we call ourselves CGI Partners rather than employees. We benefit from our collective success and actively shape our company's strategy and direction.

Your work creates value. You'll develop innovative solutions and build relationships with teammates and clients while accessing global capabilities to scale your ideas, embrace new opportunities, and benefit from expansive industry and technology expertise.

You'll shape your career by joining a company built to grow and last. You'll be supported by leaders who care about your health and well-being and provide you with opportunities to deepen your skills and broaden your horizons.