City/State
Work Shift
Overview:
Sentara is hiring a Senior Benefit Configuration Analyst!
No Degree required!
This position is fully remote!
Candidates must have a current residence in one of the following states or be willing to relocate: 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 State, West Virginia, Wisconsin, Wyoming
Overview
The Senior Benefit Configuration Analyst is responsible for the analysis, design, build, and validation of complex benefit configurations within the QNXT platform to support accurate claims adjudication and compliance. This role works closely with Product, Compliance, IT, Network and Claim’s teams to ensure benefit plans are implemented accurately, timely, and in accordance with regulatory and contractual requirements.
The senior analyst serves as a business and technical expert in QNXT benefit build and plays a key role in supporting new plan implementations, annual updates, and ongoing configuration maintenance.
Key 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.
Education
Minimum 6 years of experience, which includes 2 years of directly related experience in lieu of a bachelor’s degree required.
Or
Bachelor’s degree in healthcare administration, Information Systems, or related field with 4 years of progressive, relevant professional experience required
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