Benefit Configuration Manager

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🔥 0 minutes ago

🏈 Alabama, Florida, +24 more states – Remote

🏈 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

💵 $106.1k - $176.8k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

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Sentara Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1890

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Sentara Health is a leading healthcare system that operates over 300 sites of care in Virginia and northeastern North Carolina, including 12 acute care hospitals. The company is dedicated to providing exceptional patient care, fostering professional development, and maintaining a diverse workforce. Sentara Health aims to improve health every day and has been recognized for its clinical and operational performance, being named one of the top 15 health systems by IBM Watson Health. The organization supports its employees in achieving their full potential and encourages growth and innovation in the healthcare sector.

📋 Description

• 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.

🎯 Requirements

• 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.

🏖️ Benefits

• 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