Benefit Configuration Manager - Remote

Sentara Health; United States; Remote; USD 106,000 - 177,000; Full time

Benefits offered by this job

Medical benefits

401k with match

Paid time off

Job summary

Sentara Health is seeking a Benefit Configuration Manager to lead strategic configuration operations within the QNXT platform. The role supports Medicare, Medicaid, Commercial, and Exchange products, and collaborates with business and IT teams to implement new products and regulatory changes.

The position emphasizes governance, quality, and operational excellence, with responsibility for UAT, defect management, and performance reporting across enterprise initiatives.

Qualifications

• Bachelor’s degree or relevant experience in health plan configuration.
• 8+ years in health plan benefit configuration using QNXT or equivalent.
• 5+ years leading configuration teams or supervisors.
• Experience with Commercial, Exchange, Medicare, and Medicaid benefits and regulatory rules.
• Strong analytical, organizational, project management, and communication skills.
• Proven ability to lead cross-functional teams and drive initiatives.
• Ability to create SQL queries for validation of configuration and claims analysis.

Responsibilities

• Oversee analysis, design, configuration, implementation, and maintenance of benefit plans in QNXT.
• Ensure accurate configuration of products, plans, service codes, accumulators, limitations, and cost-share structures per regulations.
• Direct annual benefit changes, new product implementations, and market expansion efforts.
• Establish governance for configuration requests, prioritization, approvals, and deployments.
• Monitor configuration quality via KPIs, SLAs, and QA programs.
• Act as escalation point for regulatory interpretation and configuration decisions.
• Lead UAT, validation, defect management, and production readiness activities.
• Drive process improvements to enhance quality, efficiency, and scalability.
• Collaborate with IT to identify automation opportunities for configuration management.
• Provide executive reporting on configuration activities, risks, and capacity.
• Coach and manage configuration staff and establish team goals.

Skills

QNXT experience

Leadership of configuration teams

SQL validation

Regulatory knowledge

Education

Bachelor's degree or equivalent experience

Tools

QNXT tools (CMT/QCS)

SQL Server

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 degreeisrequired.

Experience:

• 3 years of related experiencein 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.

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

We 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 ifestablished 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.