Data Sheet: Business & Technical Advisory Services for HealthRules® Payer
Expert Guidance to Solve Operational Challenges, Optimize Performance, and Move Your Business Forward
Business & Technical Advisory Services for HealthRules® Payer
Health plans depend on HealthRules® Payer to manage mission-critical operations, including claims adjudication, enrollment, benefits, and billing. As business requirements change and technology evolves, plans require specialized expertise to optimize the platform and address new challenges.
HealthEdge Global Professional Services (GPS) offers Business & Technical Advisory Services to provide health plans with a trusted partner for transforming these opportunities into successful outcomes. Our advisors collaborate with HealthRules® Payer clients post-go-live to resolve system issues, evaluate performance, plan technical enhancements, and guide significant operational changes.
Unlike third-party consulting firms, HealthEdge provides unmatched product knowledge, direct access to product engineering teams, and a commitment to your long-term success through our ongoing SaaS partnership.
Why Health Plans Engage Our Advisory Services
Clients turn to GPS for post-production advisory support when they need:
- Expert assistance to solve complex HealthRules® Payer challenges that exceed internal capabilities.
- Guidance on implementing major technical or operational changes, such as new integrations or product lines.
- Advice for optimizing system performance affected by years of accumulated configuration, custom code, or process drift.
- Support in preparing for major upgrades, new features, or architectural changes.
- A partner who understands the HealthRules® Payer environment end-to-end and can translate problems into actionable solutions.
Common Focus Areas for Business & Technical Advisory Services
Our advisory services are designed to address a wide range of operational and technical needs. Key focus areas include:
System Optimization & Performance Assessment
HealthEdge advisors conduct focused reviews of critical HealthRules® Payer processes to identify performance bottlenecks, configuration issues, and unused capabilities. Through structured discovery, we recommend improvements to help you modernize your platform utilization.
- Typical Use Cases:
- Evaluating aging or complex system configurations
- Reducing pending claims and improving run times
- Streamlining workflows to enhance performance
- Identifying new or underutilized features for adoption
New Integrations & Technical Enhancements
When introducing or upgrading an integration, GPS provides the architectural guidance, technical design support, and domain expertise to ensure a successful implementation.
- Typical Use Cases:
- Adding a new vendor integration
- Replacing an existing vendor and re-architecting data flows
- Optimizing legacy integrations for accuracy and efficiency
- Supporting new technical feature implementations, such as SSO
New Lines of Business & Major Operational Changes
Adding a new government program, employer group, or commercial product involves complex changes to data, integrations, and configurations. GPS advisors help you assess requirements, plan the work, and ensure HealthRules® Payer is ready to support the new business.
- Typical Use Cases:
- Launching a new Medicare, Medicaid, or Marketplace product
- Supporting data migration required for new lines of business
- Establishing or expanding integration ecosystems
- Ensuring new business configuration aligns with best practices
Release & Feature Upgrade Advisory
Major release upgrades often intersect with custom code, historical configurations, and legacy workflows. Our advisors help you plan and execute upgrades with reduced risk and more predictable outcomes.
- Typical Use Cases:
- Preparing for HealthRules® Payer platform upgrades
- Evaluating readiness and potential areas of risk
- Reviewing custom code that may require updates
- Supporting environment management strategies
Our Flexible Advisory Approach
Every engagement begins with a targeted discovery session to understand your unique challenges, system context, and desired outcomes. From there, GPS delivers a tailored solution.
- Assessment and Root Cause Analysis: We begin by thoroughly analyzing the situation to identify the core issues.
- Recommendations and Actionable Guidance: Our team provides clear, data-driven recommendations.
- Roadmap or Approach Document: We deliver a strategic document outlining the path forward.
- Optional Execution Support: You can choose to have GPS experts help implement the recommended solution.
This flexible model ensures you receive the exact guidance and expertise you need—no more, no less.
The Advisory Team: Unmatched Product Expertise
Our Business & Technical Advisory Services team consists of specialized HealthRules® Payer experts who understand both the product and the business context in which it operates.
|
Role |
Key Responsibilities |
|
Principal Business Analyst |
Leads discovery, validates business requirements, and supports the configuration approach. |
|
Principal Technical Analyst |
Advises on integrations, data mapping, technical workflows, and system performance. |
|
Solution Architect |
Guides architectural decisions and ensures alignment with HRP capabilities and enterprise strategy. |
|
Delivery Executive |
Oversees the engagement, acts as the HealthEdge Executive Sponsor, and serves as the customer’s primary point of contact. |
|
Release Management Advisor |
Supports environment strategy, deployment planning, and readiness for changes or upgrades. |
Real-World Examples
Performance Optimization
A health plan experiencing long claim run times engaged GPS for a performance review. After assessing configuration, integrations, and job sequencing, our team recommended targeted adjustments that significantly reduced overall runtime and cleared a large claims backlog.
New Integration Implementation
A customer needed to onboard a new vendor and re-architect their data flow. GPS provided the mapping guidance, architectural support, and technical expertise required to successfully design and implement the new integration.
New Line of Business Support
A plan expanding into Medicare required multiple new integrations and a data migration effort. GPS advisors defined the approach, identified risks, and guided the customer through the planning needed to confidently launch the new line of business.
Move Forward with Confidence
Whether you are facing a system bottleneck, preparing for a major change, or simply need expert guidance, HealthEdge GPS Business & Technical Advisory Services provides the HealthRules® Payer expertise and partnership needed to achieve your goals.
To learn more about how we can help you unlock more value from your HealthEdge solutions, contact your Customer Success Executive.
