HRP Migration Architect
Location: Canton, MA preferred
Position Description
Lead architect for the migration of a healthcare payer's core claims platform from a legacy claims engine to HealthEdge HealthRules Payer (HRP) as the target system. You own the target state architecture, migration strategy, and integration design from discovery through cutover and stabilization.
Your future duties and responsibilities
. Target state architecture: Define the HRP solution architecture across Member, Product/Benefit, Provider, Claims, and financial modules, and keep it aligned with the enterprise architecture.
. Migration strategy: Design the end-to-end approach, including data migration (extract, transform, load, reconcile), cutover options (big bang vs. phased/LOB wise), parallel runs, and rollback.
. Legacy to HRP mapping: Lead gap/fit analysis and data mapping from legacy structures to HRP's data model. Resolve configuration vs. customization decisions.
. Configuration oversight: Guide benefit plan, product, pricing/fee schedule, contract, accumulator, and adjudication rule configuration in HRP.
. Integration and EDI design: Own the integration landscape around HRP: X12 transactions: 837 (P/I/D), 835, 834, 820, 270/271, 276/277, 278 Clearinghouse, enrollment, eligibility, and billing flows Downstream feeds: finance/GL, pharmacy (PBM), UM/care management, data warehouse, reporting APIs and event/messaging patterns, plus interoperability touchpoints (e.g., CMS 0057 API dependencies)
. Data quality and reconciliation: Define migration validation, financial and claims reconciliation, and open claim/in flight transition rules.
. Testing and readiness: Shape the QE strategy (system, integration, end to end, UAT, regression, performance). Define entry/exit criteria and go live readiness.
. Governance and leadership: Act as technical authority with the client, HRP vendor, and delivery teams. Own design decisions, risk/issue management, and architecture review boards.
. Stakeholder communication: Translate technical decisions for business, operations, and executive audiences.
Required qualifications to be successful in this role
. 10+ years in healthcare payer technology, with 5+ years of hands on HRP experience
. Led at least 1 2 full core claims migrations to HRP (not just implementation or support)
. Deep functional and technical knowledge of HRP modules: Member, Product, Provider, Claims, Financials
. Strong command of HIPAA X12 EDI and how it maps to HRP inbound/outbound processing
. Proven data migration experience at payer scale (conversion design, mapping, reconciliation, mock loads)
. Solid understanding of claims adjudication, pricing, accumulators, COB, appeals, and payment/remit processes
. Experience with integration patterns (APIs, MQ/ESB, ETL, batch vs. real time)
. Familiarity with regulatory requirements (HIPAA, CMS, state mandates)
. Strong executive level communication and client facing leadership
Preferred qualifications
. HealthEdge certifications or direct HealthEdge partner/vendor experience
. Experience with multiple LOBs (Commercial, Medicare Advantage, Medicaid, Exchange)
. Exposure to cloud hosted HRP deployments and DevOps/CI CD for configuration promotion
. Experience applying AI/automation to migration testing, mapping, or reconciliation
. Background in payer mergers or multi entity platform consolidations
Education: Bachelor's degree in computer science or similar field.