Senior Benefit Configuration Analyst – QNXT

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🔥 18 horas atrás

⚔️ Virginia – Remoto

⚔️ Virginia – Remote

💵 $69.867 - $116.438 / ano

⏰ Tempo Integral

🟠 Sênior

🧐 Analista

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Sentara Health

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1890

⚕️ Seguro de Saúde

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

• Analyze benefit plan documentation (e.g., EOCs, SOBs) and translate into QNXT configuration requirements. • Build and configure new and updated benefits in QNXT, including Product, Plan, Service Codes, Copay/Coinsurance, Accumulators, Limits, and Authorization rules. • Use QNXT Configuration Management Tool (CMT) and QNXT Configuration Console Suite (QCS) to manage configuration packages and perform impact analysis. • Execute back-end data validations using SQL to ensure configuration accuracy and resolve complex issues. • Participate in end-to-end testing (UAT) of benefit builds and coordinate defect resolution with QA and claims teams. • Support annual benefit configuration activities such as Medicare, Medicaid contract updates, or Exchange plan changes. • Serve as a subject matter expert (SME) for benefit build logic, configuration architecture, and claims-related business rules. • Document configuration logic and maintain version-controlled artifacts for audit and compliance purposes. • Provide mentorship and support to junior configuration analysts and assist in training initiatives. • Collaborate with cross-functional teams during product launches, regulatory changes, or system upgrades.

🎯 Requisitos

• Minimum 6 years of experience, which includes 2 years of directly related experience in lieu of a bachelor’s degree required. • Or Bachelor’s degree in healthcare administration, Information Systems, or related field with 4 years of progressive, relevant professional experience required • Required to have hands-on benefit configuration experience, preferably in a managed care or health plan environment. • Required to have a strong working knowledge of QNXT system architecture, including configuration tables, benefit logic, and claims integration. • Required to have strong understanding of regulatory requirements across Medicare, Medicaid, ACA, and Commercial plans. • Required to have excellent analytical, organizational, and problem-solving skills. • Strong written and verbal communication including technical documentation. • Excellent interpersonal skills and team oriented. • Preferred Qualifications: Proficiency in Microsoft SQL Server (T-SQL) for data validation and troubleshooting. • Experience with CMT and QCS tools for version management, configuration migrations, and build monitoring. • Familiarity with implementation methodologies for new products or market launches. • Knowledge of healthcare claims lifecycle, pricing, and accumulators. • Lean Six Sigma or process improvement background is a plus.

🏖️ 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 • Reimbursement for certifications and free access to complete CEUs and professional development • Pet Insurance • Legal Resources Plan • Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.