Benefit Configuration Manager - Remote

Sentara Health•Miami, FL

9d•$111,821 - $180,586•Remote

About The Position

The Benefit Configuration Manager provides strategic leadership, oversight, and execution of benefit configuration operations within the QNXT platform. The role manages the end-to-end benefit configuration lifecycle, ensuring accurate implementation and maintenance of Medicare, Medicaid, Commercial, and Exchange products in support of claims adjudication, regulatory compliance, and organizational objectives. The manager leads configuration supervisors and analysts, establishes operational standards, drives continuous improvement, and partners with business and technology teams on new products, regulatory changes, and system enhancements. This position serves as a key subject matter expert and leader for benefit configuration strategy, governance, quality, and operational excellence. The position is fully remote. Sentara Health employs remote associates in the states listed in the posting, including Florida.

Requirements

Bachelor's degree in Healthcare Administration, Information Systems, Business Administration, or a related field; direct experience may be considered in lieu of a degree. The posting also states that no specific degree is required.
At least 8 years of progressive health plan benefit configuration experience using QNXT or a comparable claims administration platform.
At least 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 benefit configuration validation and claims analysis.
Three years of related experience in operations, IT, or reporting is also listed as required.

Nice To Haves

Working knowledge of QNXT architecture, 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.

Responsibilities

Oversee 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 in compliance with contractual requirements and applicable CMS, Medicaid, and ACA regulations.
Direct annual benefit changes, new product implementations, regulatory updates, and market expansion efforts.
Establish and maintain governance for configuration requests, prioritization, approvals, and production deployments.
Monitor configuration quality, accuracy, and timeliness using 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 process improvements to improve quality, efficiency, scalability, and operational effectiveness.
Collaborate with IT to identify automation opportunities and improve configuration management capabilities.
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.
Lead, coach, and manage performance of QNXT Benefit Configuration Supervisors and configuration staff.
Establish team goals, performance metrics, and productivity standards aligned with organizational objectives.

Benefits

Medical, dental, and vision plans.
Adoption, fertility, and surrogacy reimbursement up to $10,000.
Paid time off and sick leave.
Paid parental and family caregiver leave.
Emergency backup care.
Long-term and short-term disability and critical illness plans.
Life insurance.
401(k)/403(b) with employer match.
Tuition assistance of $5,250 per year and discounted educational opportunities through Guild Education.
Student debt pay down up to $10,000.
Pet insurance.
Legal resources plan.
Opportunity to earn an annual discretionary bonus, subject to system and employee eligibility criteria.
Comprehensive benefits package including medical, dental, vision, life and disability insurance, paid vacation and holidays, paid parental and military leave, educational assistance or student loan repayment, and voluntary benefits.