Sentara Healthcare Inc
Supervisor, QNXT Benefit Configuration - Remote
Sentara Healthcare Inc, Richmond, Virginia, United States, 23214
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. 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
Bachelor’s degree in Healthcare Administration, Information Systems, or related field (or equivalent experience). Certification/Licensure
No specific certification or licensure requirements Experience
Required Qualifications: Bachelor’s degree in Healthcare Administration, Information Systems, or related field (or equivalent experience). 3–5 years of experience in benefit configuration within QNXT or a similar claims adjudication system. 1–3 years of supervisory or team lead experience. 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 Trizetto’s QNXT core administration system. Knowledge of CMS model benefits and Medicaid waiver programs. Familiarity with other systems such as Facets, HealthEdge, or Amisys is a plus. Process improvement or Lean Six Sigma background.
#J-18808-Ljbffr
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. 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
Bachelor’s degree in Healthcare Administration, Information Systems, or related field (or equivalent experience). Certification/Licensure
No specific certification or licensure requirements Experience
Required Qualifications: Bachelor’s degree in Healthcare Administration, Information Systems, or related field (or equivalent experience). 3–5 years of experience in benefit configuration within QNXT or a similar claims adjudication system. 1–3 years of supervisory or team lead experience. 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 Trizetto’s QNXT core administration system. Knowledge of CMS model benefits and Medicaid waiver programs. Familiarity with other systems such as Facets, HealthEdge, or Amisys is a plus. Process improvement or Lean Six Sigma background.
#J-18808-Ljbffr