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Benefit Configuration Manager - Remote

Sentara Health Administration, Inc.
Doral, FL

Quick Apply

Job Details

Full-time
$106,080.00 - $176,820.80 a year
1 day ago

Benefits

403(b) matching
Paid parental leave
Caregiver leave
Disability insurance
Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Parental leave
Vision insurance
401(k) matching
403(b)
Life insurance
Pet insurance

Qualifications

Medicare
Project management experience in technology
Health insurance policy knowledge
SQL
Medicare regulations
Task prioritization
Project management experience in healthcare
Leading team collaboration initiatives
Managing projects
Medicaid regulations
Medicaid
Query management
Cross-functional team management
Project stakeholder communication
Stakeholder relationship building
Cross-functional communication
Stakeholder management

Full Job Description

City/State

Doral, FL

Work Shift

First (Days)

Overview:

Sentara is hiring a Benefit Configuration Manager!

This position is fully remote.

Overview

The Benefit Configuration Manager is responsible for the strategic leadership, oversight, and execution of benefit configuration operations within the QNXT platform. This 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 initiatives, and partners with cross-functional business and technology teams to implement new products, regulatory changes, and system enhancements. The Benefit Configuration Manager serves as a key leader and subject matter expert for benefit configuration strategy, governance, quality, and operational excellence.

Key Responsibilities

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 in compliance with plan contractual requirements, CMS, Medicaid, ACA regulations.
Direct annual benefit change activities, new product implementations, regulatory updates, and market expansion efforts.
Establish and maintain governance processes for configuration requests, prioritization, approvals, and production deployments.
Monitor configuration quality, accuracy, and timeliness through established KPIs, SLAs, and quality assurance programs.
Serve as an escalation point for complex regulatory interpretation and benefit implementation decisions.
Act as the business owner and primary configuration representative for enterprise projects and strategic initiatives.

Oversee User Acceptance Testing (UAT), configuration validation, defect management, and production readiness activities.
Drive continuous process improvement initiatives that improve quality, efficiency, scalability, and operational effectiveness.
Collaborate with IT to identify automation opportunities and enhance 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.
Provide leadership, coaching, and performance management for QNXT Benefit Configuration Supervisors and configuration staff.
Establish team goals, performance metrics, and productivity standards aligned with organizational objectives.

Required Qualifications

Bachelor's degree in Healthcare Administration, Information Systems, Business Administration, or related field; In lieu of degree, direct experience will be considered.
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.
Demonstrated expertise in Commercial, Exchange, Medicare, and Medicaid benefit designs and regulatory requirements.
Extensive knowledge of benefit configuration logic, claims adjudication, accumulators, 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.
Proven ability to lead cross-functional teams and drive organizational initiatives.
Proven ability to create SQL queries for validation of benefit configuration and claims analysis

Preferred Qualifications

Working knowledge of QNXT architecture and Benefit configuration 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.

Education:

No specific degree is required.

Experience:

3 years of related experience in one of the following areas, operations, IT, or reporting. (Required)

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for full-time employment is: $106,080.00 - $176,820.80. Additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Talroo-IT, health plan, QNXT, benefit configuration, configuration management tool, CMT, QNXT configuration Console Suite, QCS, PMP, Agile, health plan, UAT, healthcare, benefit configuration, Medicaid, commercial, Medicare, governance, quality assurance

Benefits: Caring For Your Family and Your Career

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
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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configuration manager jobs in doral fl

Benefit Configuration Manager - Remote

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