Job Description

1. Provide strategic management and direction for the configuration of health plan products, provider networks, and reimbursement methodologies to ensure alignment with business requirements, state and federal regulations, and accreditation standards.
2. Develop and implement policies, standards, and governance frameworks for configuration accuracy, quality control, and compliance.
3. Collaborate with external partners, IT, Claims Operations, Provider Services, Compliance, and Product teams to ensure system configurations support new products, regulatory changes, and organizational initiatives.
4. Lead testing, validation, and sign-off processes for new configurations, system upgrades, and change requests
5. Drive process improvements and automation opportunities to enhance configuration efficiency and reduce errors.
6. Serve as a subject matter expert (SME) for configuration management, providing training, guidance, and mentorship to internal and external team members and business stakeholders.
7. Performs all other miscellaneous responsibilities and duties as assigned or directed.

1. Bachelor's degree and five years of related work experience; or equivalent combination of education and related work experience.
2. Five years of management/supervisory experience.
3. In-depth knowledge of managed care, PPO, HMO, Medicaid, Medicare Advantage, and commercial group health plans
4. Strong working knowledge of claims adjudication systems (e.g., Facets, QNXT, Epic Tapestry, HealthEdge)
5. Effective written and verbal communication skills
6. Intermediate knowledge of Microsoft Office applications including, but not limited to Word, Powerpoint, Outlook and Excel.