COE Configuration Leader: Quality, Audits & Transformation

Medica; Minnetonka (MN); On-site; USD 100,000 - 172,000; Full time

Benefits offered by this job

Generous total rewards package

Competitive medical, dental, vision

Paid time off (PTO) and Holidays

401K contributions

Job summary

Medica is seeking a Manager for the Configuration Center of Excellence (COE) to lead a team of Business Analysts and Quality Auditors across configuration delivery. You will define governance, improve controls, and drive scalable processes in a health plan environment with a focus on quality and compliance.

You will partner with multiple departments to advance COE strategy, establish standards, and expand value while preparing the COE to support additional configuration teams.

Qualifications

• Bachelor's degree in Business Administration, MIS, IT, Healthcare Administration, or equivalent combination of education and experience.
• 5+ years of experience in healthcare operations, business configuration, business analysis, quality assurance, process improvement, or a related area.
• 2+ years of people leadership experience.
• Experience working within the HealthRules Payor ecosystem.
• Experience leading operational improvement initiatives or developing new business functions.

Responsibilities

• Establish configuration quality standards, audit frameworks, and governance processes.
• Oversee production, operational, service, and ad hoc configuration audits.
• Develop audit methodologies, quality controls, documentation standards, and reporting processes.
• Monitor completed configuration work to identify errors, trends, risks, and opportunities for improvement.
• Communicate audit findings and recommendations to Configuration Delivery leadership.
• Partner with Business Analysts and operational teams to address recurring process issues.
• Support corporate audit activities, including regulatory, compliance, and internal audit reviews.
• Maintain centralized audit documentation, findings, and historical reporting.
• Ensure adherence to configuration standards, internal controls, and regulatory requirements.
• Lead continuous improvement initiatives across business configuration operations.
• Oversee claims impact reporting related to retroactive configuration changes.
• Partner with Claims and Configuration Delivery teams to support claims reprocessing efforts.
• Analyze root causes of retroactive changes, including configuration errors, requirements gaps, and operational delays.
• Recommend process improvements, training opportunities, and enhanced controls based on findings.
• Improve work intake, prioritization, assignment, tracking, and visibility processes.
• Collaborate with business and technology teams to identify automation opportunities.
• Establish operational standards that support consistency, efficiency, and scalability.
• Measure and communicate business outcomes and operational improvements.
• Oversee development and maintenance of training materials, job aids, standard operating procedures, process flows, and configuration documentation.
• Coordinate training programs with configuration leadership, subject matter experts, and learning partners.
• Identify training needs based on audit results, operational trends, and business requirements.
• Support onboarding, cross-training, and ongoing employee development initiatives.
• Ensure training and process documentation remains current and accurate.
• Foster knowledge sharing and best practice adoption across configuration teams.
• Lead Business Analyst support for configuration and enterprise-wide initiatives.
• Establish standards and best practices for business requirements gathering and documentation.
• Partner with stakeholders to define requirements and translate business needs into actionable solutions.
• Support implementation planning and transition activities from project delivery to operations.
• Advise stakeholders on configuration impacts, risks, dependencies, and implementation considerations.
• Promote governance, documentation, and stakeholder alignment throughout project lifecycles.
• Expand COE support capabilities across benefits, claims, provider, health services, and other configuration functions.

Skills

Healthcare operations

Quality auditing

Leadership

Process improvement

Governance

Auditing

Data analysis

Education

Bachelor's degree in Business Administration, MIS, IT, Healthcare Administration

Tools

GuidingCare

HealthRules Payor

Job description

Medica is seeking a Manager for the Configuration Center of Excellence (COE) to lead a team of Business Analysts and Quality Auditors across configuration delivery. You will define governance, improve controls, and drive scalable processes in a health plan environment with a focus on quality and compliance.

You will partner with multiple departments to advance COE strategy, establish standards, and expand value while preparing the COE to support additional configuration teams.