Benefit Configuration Manager - Remote

Sentara Health Administration, Inc.; Florida; Remote; USD 112,000 - 181,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with employer match

Paid Time Off

Educational assistance

Student Debt Pay Down – $10,000

Job summary

Sentara Health Administration, Inc. is seeking a Benefit Configuration Manager to lead the configuration of Medicare, Medicaid, Commercial, and Exchange products on the QNXT platform.

This fully remote role focuses on governance, quality, and strategic initiatives, supervising the configuration team while coordinating with IT and business stakeholders. You will drive annual benefit changes, regulatory updates, and new product implementations.

Qualifications

• 8+ years of progressive experience in health plan benefit configuration using QNXT or a comparable 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 maintenance activities.
• Strong analytical, organizational, and problem-solving skills.

Responsibilities

• Oversee analysis, design, configuration, implementation, and maintenance of benefit plans within QNXT.
• Ensure accurate configuration of products, plans, service codes, accumulators, and cost-share structures.
• Direct annual benefit change activities, new product implementations, and regulatory updates.
• Establish governance for configuration requests, prioritization, approvals, and deployments.
• Monitor configuration quality with KPIs, SLAs, and QA programs.
• Lead UAT, validation, and production readiness activities.
• Provide executive reporting on configuration activities, risks, and capacity.
• Coach and manage QNXT configuration Supervisors and staff.

Skills

Leadership

Regulatory compliance

QNXT platform

SQL queries

Stakeholder management

Project management

Analytics

Education

Bachelor's degree in Healthcare Administration or related field

Experience accepted in lieu of degree

Tools

QNXT Configuration Tool (CMT)

QNXT Configuration Console Suite (QCS)

SQL Server

Job description

City/StateDoral, FLWork ShiftFirst (Days)Overview:Sentara is hiring a Benefit Configuration Manager!This position is fully remote.OverviewThe 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 ResponsibilitiesOversee 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 QualificationsBachelor'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 rulesExperience 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 analysisPreferred QualificationsWorking 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)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 assuranceWe provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay range for full-time employment is $111,820.80 - $180,585.60 annually. Additional compensation may be available for this role, such as shift differentials, on-call pay, shift premiums, extra-shift incentives, or bonus opportunities. Compensation within the range may vary based on qualifications, experience, location, market conditions, and business needs. Note: If an annual salary is posted, it is based on a full-time colleague working 2,080 hours annually. Sentara offers a comprehensive benefits package, including medical, dental, vision, life and disability insurance; 401(k)/403(b) with employer match; paid time off (vacation, sick time, and holidays); paid parental and military leave; educational assistance or student loan repayment; and voluntary benefits.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.