Claim Configuration Analyst Jobs (NOW HIRING)

City/State
Richmond, VA
Work Shift
Multiple shifts available
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
  

Certification/Licensure

• No specific certification or licensure requirements

Experience

• 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.

Preferred Qualifications

• 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.

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is: $ 69,867.20 - $ 116,438.40. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
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Benefits: Caring For Your Family and Your Career
• 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 ifestablished system and employee eligibility criteria is met.
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.