HealthRules Payer (HRP)

Job Summary We are seeking an experienced Healthcare Claims Tester / Business Analyst with strong expertise in HealthRules Payer (HRP), healthcare claims processing, EDI transactions, and Blue Card workflows. The ideal candidate will possess deep healthcare domain knowledge and hands\-on experience validating claims adjudication, benefits configuration, pricing, and payment processes within HealthRules Payer environments. This role requires close collaboration with business stakeholders, operations teams, developers, and QA teams to ensure accurate claims processing and successful delivery of healthcare system enhancements, integrations, and testing initiatives. Required Skills * Healthcare Claims Processing * HealthRules Payer (HRP) * EDI 837 Transactions * Blue Card Processing * Healthcare Domain Knowledge * Claims Testing * Azure DevOps or similar test management tools * SQL for data validation and analysis Key Responsibilities * Analyze business requirements and translate them into comprehensive test scenarios and test cases. * Design, execute, and validate functional, integration, regression, and end\-to\-end claims testing activities. * Validate healthcare claims processing workflows, including adjudication, benefits, pricing, and payment calculations. * Perform testing and validation of EDI 837 claim transactions and related healthcare data exchanges. * Support Blue Card claims processing and HRP\-to\-TPA integration workflows. * Review claims\-processing results, identify defects, and collaborate with business and technical teams to resolve issues. * Validate benefits configuration, package pricing, and claims rules within HealthRules Payer. * Troubleshoot production issues related to claims processing and benefit configurations. * Execute SQL queries for claims validation, reconciliation, and data analysis. * Participate in healthcare system migrations, integrations, upgrades, and major HRP enhancement projects. * Ensure compliance with BCBS Association requirements and Blue Card mandates. * Maintain testing documentation, defect tracking, and test execution records using Azure DevOps or similar tools. * Collaborate effectively with business users, operations teams, developers, and project stakeholders. Required Qualifications * 4\+ years of experience in healthcare claims processing, healthcare operations, claims testing, or related healthcare systems roles. * Strong hands\-on experience with HealthRules Payer (HRP), including local claims processing. * Experience working with and validating EDI 837 transactions. * Experience supporting Blue Card claims processing and/or HRP\-to\-TPA workflows. * Strong understanding of the healthcare claims lifecycle, adjudication, benefits administration, pricing, and payment workflows. * Knowledge of healthcare and health\-plan terminology. * Experience working with industry\-standard healthcare codes, including: * CPT * HCPCS * ICD\-9 * ICD\-10 * CDT * Revenue Codes * DRG Codes * Experience