Supervisor, QNXT Benefit Configuration - Remote

Supervisor, QNXT Benefit Configuration

Richmond, VA

First (Days)

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 :

• Bachelor's degree in Healthcare Administration, Information Systems, or related field (or equivalent experience).

Certification / Licensure :

Experience :

Required Qualifications :

Bachelor's degree in Healthcare Administration, Information Systems, or related field (or equivalent experience).

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

13 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.

Benefits : Caring For Your Family and Your Career

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-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.