Senior Strategic Configuration Analyst
Core
Technical validation and rigorous testing of configuration logic to maximize first-pass claim payment accuracy in Medicare Advantage plans.
Role type
Senior Strategic Configuration Analyst (QA/Testing)
Builds
Production-ready configuration logic for claim adjudication systems
Domain
Healthcare insurance / Medicare Advantage / Claims processing
Deliverable
production ML models | product features | dashboards & analysis | infrastructure
Required skills
Medicare Advantage configuration, HealthEdge HRP and Source, scenario-based modeling, defect impact analysis, root cause testing, AI-enabled testing (LLMs), CMS regulations knowledge, end-to-end claim lifecycle understanding
Preferred skills
Edge case identification, complex reimbursement logic, strategic configuration updates
Technologies
HealthEdge HRP, HealthEdge Source, LLMs (Claude, Gemini, ChatGPT)
Responsibilities
Architect and execute test plans for member benefits and provider contract terms; Develop and execute complex scenario-based testing models; Provide detailed failed-test analysis and comprehensive impact assessments; Manage technical validation lifecycle across testing and UAT environments; Simulate scenarios to confirm root cause of payment variances; Support evolution of testing frameworks using LLMs; Maintain detailed records of test results and configuration procedures
Seniority
Senior, hands-on IC