Sr. Manager, Quality Assurance Benefit Config

Navitus Health Solutions, LLC•,

8d•$108,429 - $135,536•Remote

About The Position

Due to growth, we are adding a Sr. Manager, Quality Assurance Benefit Configuration to our team! The Sr. Manager, Quality Assurance Benefit Configuration leads the Quality Assurance function responsible for benefit configuration verification and accuracy, ensuring alignment with client requirements and internal quality expectations across all lines of business. The Sr. Manager oversees a team of Quality Assurance Analysts, driving the execution of benefit configuration testing, validation, and audit activities to ensure the accuracy and integrity of claims adjudication within the NCRx system. The Sr. Manager is accountable for establishing and maintaining quality assurance standards, processes, and workflows that support accurate, efficient, and scalable validation practices, while ensuring effective execution across new client implementations, benefit changes, and ongoing maintenance to mitigate risks related to member access, compliance, and financial exposure.

Requirements

Bachelor's degree or equivalent work experience required.
6+ years of relevant work experience in the healthcare industry in benefit confirmation, operations, or quality assurance required.
5+ years of experience leadership in PBM, healthcare operations, or similar industry required.
4+ years of work experience using MS Excel filtering, sorting, and analyzing data with ability to write complex formulas required.
Knowledge of government programs such as Medicare or Medicaid, network pricing, and formulary required.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.

Nice To Haves

PBM experience preferred.
Strong PBM Quality Assurance validation and testing knowledge preferred.

Responsibilities

Lead and oversee a team of Quality Assurance Analysts, ensuring effective execution of benefit configuration testing, validation, and audit activities.
Ensure accurate and timely completion of complex quality assurance for new client implementations, benefit changes, and ongoing maintenance across all lines of business.
Establish and enforce quality assurance standards, procedures, and audit methodologies, ensuring compliance with internal requirements.
Provide oversight on root cause analysis, issue resolution, and corrective action planning, ensuring issues are identified, tracked, and resolved effectively by partnering with Issue Management Team.
Collaborate cross-functionally to drive process improvement, automation, and scalable initiatives to enhance efficiency, reduce risk, and improve testing outcomes.
Oversee development and maintenance of training materials, job aids, and standard operating procedures, ensuring consistency across the team.
Support and lead client interactions, including presentations, audits, implementations, and RFP responses related to quality assurance practices.
Ensure effective use of workflow management, issue tracking, and reporting tools to support visibility, accountability, and performance tracking.
Lead and inspire high-performing teams by providing strategic direction, aligning talent and resources with organizational goals, and driving operational excellence across key initiatives.
Other duties as assigned.