Senior Benefit Configuration Manager (Remote)

sentara; United States; Remote; USD 112,000 - 181,000; Full time

Job summary

Sentara is hiring a Benefit Configuration Manager to lead the end-to-end configuration lifecycle for Medicare, Medicaid, Commercial, and Exchange products within the QNXT platform. This fully remote role requires guiding supervisors and analysts, ensuring regulatory compliance and operational excellence while partnering with cross-functional teams across IT and business units.

The ideal candidate has 8+ years in health plan benefit configuration, 5+ years leading teams, and strong SQL skills to

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 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

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.

Skills

SQL queries

Stakeholder mgmt

Project management

Analytical thinking

Education

No degree required

Tools

QNXT

CMT

QCS

SQL Server

Job description

Sentara is hiring a Benefit Configuration Manager to lead the end-to-end configuration lifecycle for Medicare, Medicaid, Commercial, and Exchange products within the QNXT platform. This fully remote role requires guiding supervisors and analysts, ensuring regulatory compliance and operational excellence while partnering with cross-functional teams across IT and business units.

The ideal candidate has 8+ years in health plan benefit configuration, 5+ years leading teams, and strong SQL skills to