Benefit Configuration Manager

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🕒 Agosto 14

🏈 Alabama, Florida, +24 estados a mais – Remoto

🏈 Alabama – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌪️ Kansas – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote ❄️ Minnesota – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $106.080 - $176.820 / ano

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Sentara Health

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1890

🏥 Saúde

⚕️ Seguro de Saúde

Healthcare • Healthcare Insurance

A Sentara Health é um sistema de saúde líder que opera mais de 300 locais de atendimento na Virgínia e no nordeste da Carolina do Norte, incluindo 12 hospitais de cuidados agudos. A empresa é dedicada a fornecer atendimento excepcional aos pacientes, promover o desenvolvimento profissional e manter uma força de trabalho diversificada. A Sentara Health pretende melhorar a saúde todos os dias e tem sido reconhecida por seu desempenho clínico e operacional, sendo nomeada um dos 15 melhores sistemas de saúde pela IBM Watson Health. A organização apoia seus funcionários a atingirem seu pleno potencial e incentiva o crescimento e a inovação no setor de saúde.

Descrição

• Oversee the analysis, design, configuration, implementation, and maintenance of benefit plans within QNXT. • Ensure accurate configuration of products, plans, service codes, accumulators, limitations, authorization requirements, and cost-share structures. • Direct annual benefit change activities, new product implementations, regulatory updates, and market expansion efforts. • Establish governance processes for configuration requests, prioritization, approvals, and production deployments. • Monitor configuration quality, accuracy, and timeliness through KPIs, SLAs, and quality assurance programs. • Serve as an escalation point for complex regulatory interpretation and benefit implementation decisions. • Act as business owner and primary configuration representative for enterprise projects and strategic initiatives. • Oversee User Acceptance Testing, configuration validation, defect management, and production readiness. • Drive continuous process improvement and collaborate with IT on automation opportunities. • Analyze trends, identify root causes of configuration defects, and implement corrective action plans. • Provide executive-level reporting on configuration activities, risks, resource capacity, and strategic initiatives. • Provide leadership, coaching, and performance management for QNXT benefit configuration supervisors and staff. • Establish team goals, performance metrics, and productivity standards.

🎯 Requisitos

• Bachelor's degree in Healthcare Administration, Information Systems, Business Administration, or related field; direct experience may be considered in lieu of degree. • 8+ years of progressive experience in health plan benefit configuration using QNXT or a comparable claims administration platform. • 5+ years of experience leading configuration teams, supervisors, or operational functions. • Expertise in Commercial, Exchange, Medicare, and Medicaid benefit designs and regulatory requirements. • Extensive knowledge of benefit configuration logic, claims adjudication, accumulators, and authorization rules. • Experience managing large-scale benefit implementations or annual benefit maintenance activities. • Strong analytical, organizational, project management, and problem-solving skills. • Excellent written, verbal, presentation, and stakeholder management skills. • Ability to lead cross-functional teams and drive organizational initiatives. • Ability to create SQL queries for validation of benefit configuration and claims analysis. • Working knowledge of QNXT architecture and benefit configuration. • Experience with QNXT Configuration Management Tool (CMT) and QNXT Configuration Console Suite (QCS). • Working knowledge of SQL Server and data validation techniques for QNXT. • Lean Six Sigma, PMP, Agile, or other process improvement/project management certifications are preferred. • Additional posting states no specific degree is required and requires 3 years of related experience in operations, IT, or reporting.

🏖️ Benefícios

• Medical, Dental, Vision plans • Adoption, Fertility and Surrogacy Reimbursement up to $10,000 • Paid Time Off and Sick Leave • Paid Parental & Family Caregiver Leave • Emergency Backup Care • Long-Term, Short-Term Disability, and Critical Illness plans • Life Insurance • 401k/403B with Employer Match • Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education • Student Debt Pay Down – $10,000 • Pet Insurance • Legal Resources Plan • Opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met • Professional development • Continued employment philosophy