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Overview:

Sentara is hiring for a Supervisor QNXT Benefit Configuration - Remote!

Overview

The Supervisor QNXT Benefit Configuration is responsible for overseeing the daily operations of benefit configuration activities within the QNXT platform. This role ensures accurate timely and compliant configuration of benefit plans and products in support of claims processing and member eligibility systems. The supervisor leads a team of analysts or specialists monitors quality and productivity and collaborates cross-functionally with IT compliance product and clinical teams.

Key Responsibilities:

Supervise and lead a team of benefit configuration analysts working in QNXT.

Oversee and ensure accurate benefit build and configuration for new and existing plans benefit riders and products.

Validate system configurations for compliance with CMS Medicaid and state guidelines.

Develop and maintain standard operating procedures (SOPs) and workflows.

Manage timelines and deliverables for benefit setup during annual enrollment new market launches and regulatory changes.

Collaborate with IT Claims Provider Relations and Legal/Compliance to resolve configuration-related issues.

Participate in system upgrades testing (UAT) and implementation planning.

Monitor quality assurance metrics to ensure high data integrity and adherence to SLAs.

Provide training and mentoring to staff on benefit configuration best practices and QNXT functionality.

Serve as the subject matter expert (SME) for benefit configuration policies systems and tools.

Education

• Bachelors degree in Healthcare Administration Information Systems or related field (or equivalent experience).

Certification/Licensure

• No specific certification or licensure requirements

Experience

Required Qualifications:

Bachelors degree

7 years of experience in benefit configuration within QNXT or a similar claims adjudication system.

3 Supervisor or Lead experience providing guidance to lower-level staff and managing tasks

In-depth knowledge of Medicare Medicaid ACA and/or commercial plan benefit structures.

Proficient in interpreting and implementing benefit grids SBCs and regulatory documents.

Strong understanding of claims processing and eligibility systems.

Excellent analytical and problem-solving skills.

Strong interpersonal organizational and leadership abilities.

Preferred Qualifications:

Experience with Trizettos QNXT core administration system.

Knowledge of CMS model benefits and Medicaid waiver programs.

Process improvement or Lean Six Sigma background.

We provide market-competitive compensation packages inclusive of base pay incentives and benefits. The base pay rate for Full Time employment is: $91416
- $152 380.8. Additional compensation may be available for this role such as shift differentials standby/on-call overtime premiums extra shift incentives or bonus opportunities.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30000-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.