Job 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 degree is required. 

 

Experience:  

  • 3 years of related experience in 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. Additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

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

Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 135 years in pursuit of its mission – “we improve health every day.” Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 34,000 employees, 12 hospitals in Virginia and Northeastern North Carolina including 10 hospitals with the prestigious Magnet® recognition, and the Sentara Health Plans division which serves more than 1 million members in Virginia and Florida. Sentara is recognized nationally for clinical quality and safety, and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named a Health Quality Innovator of the Year (2024), was recognized by Forbes as “America’s Best-In-State Employer” (2024), “Best Employer for Veterans” (2022, 2023), and “Best Employer for Women” (2020), and named to IBM Watson Health’s “Top 15 Health Systems” (2021, 2018).

Learn more

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A woman smiling as a healthcare worker helps her with arm exercises in a bright, sunlit room.
A woman smiling as a healthcare worker helps her with arm exercises in a bright, sunlit room.

Our Culture

At Sentara, our differences are our strengths. The unique backgrounds, skills, and experiences that each Sentara colleague brings to work make Sentara special and allow us to deliver excellent service and care to our patients, members, and communities.

Our Benefits

We are committed to consistently enhancing our training, advancement tracks, work-life benefits, and more. Our goal is to make you feel more excited to be here every day!

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Two female doctors in lab coats smiling and chatting in a hospital hallway.
Two female doctors in lab coats smiling and chatting in a hospital hallway.
Two nurses in scrubs smiling and chatting during a break, one holding a coffee cup in a bright hospital setting.
Two nurses in scrubs smiling and chatting during a break, one holding a coffee cup in a bright hospital setting.

The Sentara Nursing Experience

Making a meaningful impact on health requires compassion, dedication, continuous learning, teamwork and collaboration. At Sentara, we also recognize that in valuing the professional and personal well-being of our nurses, we build a stronger, more supportive workplace for our nurses. And that’s making us healthier from the inside out. These principles unite our nurses across various roles and locations.

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The Sentara Clinical Experience

No matter where you choose to join us, in an inpatient or outpatient setting, you will be part of an interdisciplinary Clinical team passionate about quality care and patient safety. You will have access to the tools and technologies you need to succeed and the chance to learn and grow through training and educational programs so you can advance your career as a Clinical professional.

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The Sentara Support Services Experience

Each day, the Sentara Support Services team helps improve healthcare at more than 300 Virginia and Northeastern North Carolina sites. We perform various patient care activities, provide multiple services, and handle administrative functions that support our patients and their families. These vital functions include assisting the medical team in all aspects of medical care, such as treatments, procedures, and diagnostic and laboratory testing.

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The Medical Group Experience

As part of Sentara Health, Sentara Medical Group providers have diverse opportunities across regions and inpatient and outpatient locations. For those providers based in one of 12 hospitals, we have close working relationships with the administration, ensuring a collegial and collaborative environment where all can come together around shared initiatives.

Guided by a dedicated board of providers, Sentara Medical Group not only offers leadership opportunities for its providers but also underscores the group’s crucial role in fulfilling Sentara’s overarching mission to meet the needs of our diverse patient populations, some of our most vulnerable communities. Our physicians and APPs enjoy opportunities for both personal and professional career growth through a network of resources aimed to cultivate an environment suitable for a lifelong career home.

Your Perspective Matters

Nurses are the heartbeat of our exceptional team. Our approach empowers nurses to actively participate in decision-making. Our nurses have a stake in shaping their workplace as well as their own career growth; one of the benefits of our focus on supporting and valuing team members. This framework encompasses our nursing mission, vision, values, philosophy, and the essential elements of our Professional Practice Model.

This image illustrates the Sentara Nursing Professional Practice Model. Read more about it on The Sentara Nurse Experience page.

Visual representation of the Sentara Nursing Professional Practice Model.

We Are an Equal Opportunity Employer

Sentara Health is an Equal Opportunity Employer committed to the hiring, advancement, and fair treatment of every individual. Sentara and its affiliates do not discriminate against any individual or group of individuals on the basis of race, color, religion, ancestry, national origin, marital status, age, sex, sexual orientation, gender identity or expression, genetic information, physical or mental disability, pregnancy, medical condition, veteran status or any other legally protected characteristics.

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We Are an Equal Opportunity Employer

Sentara Health is an Equal Opportunity Employer committed to the hiring, advancement, and fair treatment of every individual. Sentara and its affiliates do not discriminate against any individual or group of individuals on the basis of race, color, religion, ancestry, national origin, marital status, age, sex, sexual orientation, gender identity or expression, genetic information, physical or mental disability, pregnancy, medical condition, veteran status or any other legally protected characteristics.

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