Note: The job is a remote job and is open to candidates in USA. Sentara Health is hiring a Senior Benefit Configuration Analyst responsible for the analysis, design, build, and validation of complex benefit configurations within the QNXT platform. This role works closely with various teams to ensure benefit plans are implemented accurately and in accordance with regulatory requirements.
Responsibilities
- Analyze benefit plan documentation (e.g., EOCs, SOBs, ) and translate into QNXT configuration requirements
- Build and configure new and updated benefits in QNXT, including Product, Plan, Service Codes, Copay/Coinsurance, Accumulators, Limits, and Authorization rules
- Use QNXT Configuration Management Tool (CMT) and QNXT Configuration Console Suite (QCS) to manage configuration packages and perform impact analysis
- Execute back-end data validations using SQL to ensure configuration accuracy and resolve complex issues
- Participate in end-to-end testing (UAT) of benefit builds and coordinate defect resolution with QA and claims teams
- Support annual benefit configuration activities such as Medicare, Medicaid contract updates, or Exchange plan changes
- Serve as a subject matter expert (SME) for benefit build logic, configuration architecture, and claims-related business rules
- Document configuration logic and maintain version-controlled artifacts for audit and compliance purposes
- Provide mentorship and support to junior configuration analysts and assist in training initiatives
- Collaborate with cross-functional teams during product launches, regulatory changes, or system upgrades
Skills
- Minimum 6 years of experience, which includes 2 years of directly related experience in lieu of a bachelor's degree required
- Or a Bachelor's degree in healthcare administration, Information Systems, or related field with 4 years of progressive, relevant professional experience required
- Required to have hands-on benefit configuration experience, preferably in a managed care or health plan environment
- Required to have a strong working knowledge of QNXT system architecture, including configuration tables, benefit logic, and claims integration
- Required to have strong understanding of regulatory requirements across Medicare, Medicaid, ACA, and Commercial plans
- Required to have excellent analytical, organizational, and problem-solving skills, strong written and verbal communication including technical documentation
- Excellent interpersonal skills and team oriented
- Proficiency in Microsoft SQL Server (T-SQL) for data validation and troubleshooting
- Experience with CMT and QCS tools for version management, configuration migrations, and build monitoring
- Familiarity with implementation methodologies for new products or market launches
- Knowledge of healthcare claims lifecycle, pricing, and accumulators
- Lean Six Sigma or process improvement background is a plus
Benefits
- Medical, Dental, Vision plans
- Adoption, Fertility and Surrogacy Reimbursement up to $10,000
- Paid Time Off and Sick Leave
- Paid Parental & Family Caregiver Leave
- Emergency Backup Care
- Long-Term, Short-Term Disability, and Critical Illness plans
- Life Insurance
- 401k/403B with Employer Match
- Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
- Student Debt Pay Down – $10,000
- Reimbursement for certifications and free access to complete CEUs and professional development
- Pet Insurance
- Legal Resources Plan
- Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
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