Manager of Operations Configuration

Come Grow With Us
At Gold Coast Health Plan, we are driven to create the health plan of the future - today. We are disrupting the conventions of the health care industry by creating and applying leading-edge solutions to its many challenges.

Working at Gold Coast Health Plan means working alongside a team of committed individuals who are reshaping the organization and redefining how the needs of the whole person - health, health care, and social services and supports - are met. We are seeking collaborators, innovators, and those who are driven to be their very best.

If you are looking for a career of purpose and are passionate about having an impact on society's health care challenges, then Gold Coast Health Plan is where you should be. Here, you will be challenged and rewarded in equal measure.

About this role:

* Leadership & Team Management

o Lead, mentor, and develop a team of HRP Configuration Analysts, ensuring high performance, accountability, and continuous skill development.

o Oversee workload planning, prioritization, and resource allocation to support release cycles, regulatory updates, and operational needs.

o Conduct performance evaluations, provide coaching, and support career development for configuration staff.

* Configuration Oversight & Governance

o Own the end to end configuration lifecycle: requirements intake, design, build, testing, validation, deployment, and post release monitoring.

o Ensure configuration aligns with California regulatory requirements, Medi Cal policies, benefit designs, provider contracts, and operational rules.

o Establish and enforce configuration standards, naming conventions, documentation practices, and version control.

o Maintain traceability across requirements, design, configuration, test cases and production validation.

* Technical Configuration Responsibilities

o Oversee configuration of benefits, accumulators, pricing rules, provider contracts, fee schedules, value based rules, and claims edits using HRP tools (HealthRules Language, Designer/Manager).

o Review and approve configuration designs, ensuring accuracy, scalability, and alignment with business intent.

o Support complex configuration modeling, including multi tier benefits, DOFR logic, capitation/FFS structures, and regulatory benefit constructs.

o Troubleshoot adjudication issues, perform root cause analysis, and guide defect remediation.

* Testing & Quality Assurance

o Oversee development of test scenarios, UAT execution, and validation of financial and non financial outcomes.

o Ensure rigorous impact analysis for all configuration changes, including regression testing and cross functional review.

o Partner with QA to ensure test coverage aligns with configuration complexity and regulatory requirements.

* Cross Functional Collaboration

o Work closely with Operations, Network, Product, Compliance, and IT to translate business requirements into accurate HRP configuration.

o Participate in benefit design reviews, contract updates, regulatory change assessments, and system enhancement planning.

o Serve as a subject matter expert for HRP configuration during audits, regulatory reviews, and cross departmental initiatives.

* Continuous Improvement & Strategic Support

o Identify opportunities to streamline configuration processes, improve quality, and reduce defects.

o Contribute to playbooks, SOPs, configuration standards, and best practices.

o Support HRP upgrades, parallel testing, cutover readiness, and post go live stabilization activities.

* Any other duties assigned

* High School Graduate or General Education Degree (GED)

* 3-7 years of handson configuration experience, including at least 2 years working with HRP, across benefits, provider contracts, pricing rules, and claims edits.

* California health plan experience with strong understanding of statespecific requirements; MediCal experience strongly preferred.

* Deep understanding of payer operations, claims adjudication, reimbursement methodologies, and regulatory constructs.

* Proficiency with HRP components such as HealthRules Language, Designer/Manager (Answers/Connector a plus).

* Experience with healthcare EDI and code sets (HIPAA 837/835/834/270/271; ICD10, HCPCS, CPT, DRG, APC, NDC).

* Strong analytical skills with the ability to translate complex business requirements into accurate configuration with documented rationale.

* Demonstrated experience in test planning, UAT execution, impact analysis, and production validation.

* Excellent communication, documentation, and crossfunctional collaboration skills.

* Ability to work effectively in a remote, fastpaced environment.

* Bachelor's degree

* Three plus years' experience with Medi-Cal guidelines

* Three plus years' experience data analytics and reporting

* Two years' experience in a Supervisor, Lead, Trainer, Quality Assurance or Auditor role

* Three years' experience using analytical thinking skills and demonstrated ability to exercise sound judgment when making decisions

* Experience with MediCal managed care contract constructs and operational requirements.

* Exposure to broader HRP functional areas (enrollment, billing, provider, finance, medical management/GuidingCare).

* Experience with HRP implementations, conversions, or major upgrade cycles.

* Familiarity with configuration governance frameworks and release management processes.

Technology & Software Skills: Advanced computer skills in MS Office products.

Certifications & Licenses:

Competency Statements

* Business Acumen - Ability to grasp and understand business concepts and issues.

* Communication, Oral - Ability to communicate effectively with others using the spoken word.

* Communication, Written - Ability to communicate in writing clearly and concisely.

* Research Skills - Ability to design and conduct a systematic, objective, and critical investigation.

* Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

The estimated pay range for the position is:

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.