Supervisor, QNXT Benefit Configuration

Sentara Hospitals•Richmond, VA

10d•Remote

About The Position

The Supervisor, QNXT Benefit Configuration, is responsible for overseeing the daily operations of benefit configuration activities within the QNXT platform. This role ensures accurate, timely, and compliant configuration of benefit plans and products in support of claims processing and member eligibility systems. The supervisor leads a team of analysts or specialists, monitors quality and productivity, and collaborates cross-functionally with IT, compliance, product, and clinical teams.

Requirements

Bachelor’s degree or 7+ years of experience in benefit configuration within QNXT or a similar claims adjudication system.
3+ Supervisor or Lead experience providing guidance to lower-level staff and managing tasks
In-depth knowledge of Medicare, Medicaid, ACA, and/or commercial plan benefit structures.
Proficient in interpreting and implementing benefit grids, SBCs, and regulatory documents.
Strong understanding of claims processing and eligibility systems.
Excellent analytical and problem-solving skills.
Strong interpersonal, organizational, and leadership abilities.

Nice To Haves

Experience with Trizetto’s QNXT core administration system.
Knowledge of CMS model benefits and Medicaid waiver programs.
Process improvement or Lean Six Sigma background.

Responsibilities

Supervise and lead a team of benefit configuration analysts working in QNXT.
Oversee and ensure accurate benefit build and configuration for new and existing plans, benefit riders, and products.
Validate system configurations for compliance with CMS, Medicaid, and state guidelines.
Develop and maintain standard operating procedures (SOPs) and workflows.
Manage timelines and deliverables for benefit setup during annual enrollment, new market launches, and regulatory changes.
Collaborate with IT, Claims, Provider Relations, and Legal/Compliance to resolve configuration-related issues.
Participate in system upgrades, testing (UAT), and implementation planning.
Monitor quality assurance metrics to ensure high data integrity and adherence to SLAs.
Provide training and mentoring to staff on benefit configuration best practices and QNXT functionality.
Serve as the subject matter expert (SME) for benefit configuration policies, systems, and tools.

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
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.