Health Plan Configuration Manager
1 нед. назад
98k–130k USD / yearLeadRemote
ediclaims management
Manager responsible for overseeing health plan configuration strategy execution and leading a team to scale claims configuration infrastructure for health plans.
О компании
- We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space.
- We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized.
- Our clients love us. Customer satisfaction rates among employees using health plans consistently rank above 80% – nearly 40 points above the industry average.
- Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at care deeply about making a positive impact in the lives of the people we serve.
Обязанности
- We're looking for a Manager of Health Plan Configuration to oversee the execution of our configuration strategy for the claims system and related technologies across 's rapidly-growing book of level-funded health plans. This leader will report to the Director of Configuration and be responsible for translating the long-term roadmap into day-to-day execution, building and developing a high-performing team and driving accuracy, efficiency, and scalability across our claims configuration infrastructure. This role carries meaningful latitude to shape process, policy, and team structure in service of that vision, and is expected to represent Configuration in cross-functional forums.
Требования
- 6+ years of claims system subject matter expertise, including 3+ years leading teams, team leads, or managers in a configuration, claims operations, or healthcare IT function
- Demonstrated ability to operate as a strategic partner to senior leadership, not just an executor — translating ambiguous direction into clear plans and driving them to completion
- Proven track record influencing senior and executive stakeholders, and driving organizational or process change at scale
- Strong executive presence, communication, and cross-functional relationship-building skills
- Experience owning budget, vendor contracts, or SLAs, and making resource trade-off decisions
- Ability to operate strategically while remaining close enough to the details to guide the team through complex technical and configuration problems
- Ability to deal with ambiguity, shift gears comfortably, and take decisive action without having the total picture
- Strong organizational, time management, and prioritization skills, with the judgment to know what needs executive visibility versus what the team should own
- Working knowledge of EDI transaction standards (837, 835, 834, 278) and how they integrate with claims configuration and adjudication
Условия
- Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, ’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, transportation perks, education reimbursement, and 2 days of paid paw-ternity leave.
Другое
- Hi, we’re . Our mission is to create health benefits that actually benefit small and midsize businesses and their employees. Our innovative benefit solutions and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.
- Execute the configuration strategy and roadmap, translating vision into actionable priorities and aligning the team with company growth and product objectives
- Lead, develop, and scale a team of configuration and EDI analysts, including hiring, mentoring, performance management, and succession planning as the function grows
- Partner with the leadership and cross-functional stakeholders (Product, Engineering, Operations, Finance) to align configuration capacity and priorities with broader business initiatives
- Manage vendor relationships for configuration-related partners, including SLA monitoring, performance management, and escalation resolution
- Develop and maintain a logical taxonomy of benefit categories, networks, plans, and configuration structures
- Oversee technical support for claim loading, EDI transactions (837, 835, 278), and related system troubleshooting
- Own EDI trading partner and clearinghouse relationships, ensuring compliance with X12 standards and timely resolution of transaction errors
- Support execution of the automation roadmap, deploying updates that yield measurable efficiency and quality improvements
- Establish and enforce policies, controls, and QA standards for configuration accuracy, ensuring documentation and compliance practices hold up under audit
- Manage staffing and resource planning for the configuration function, in partnership with the leadership on broader investment decisions
- Provide strategic input and visibility to the Director and executive leadership on KPIs, risk, capacity, and performance trends across Configuration and EDI
- Lead cross-functional coordination during high-stakes periods (open enrollment, Q4, system upgrades), managing risk and prioritization across departments
- Serve as a senior subject matter expert on 's claims system and configuration operations
- Act as the primary escalation point for complex, high-stakes configuration and EDI issues, exercising independent judgment to resolve risk before it reaches leadership
- Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic, and outcome oriented
- Experience operating in a regulated healthcare or health plan environment
- Experience supporting system integrations, or large-scale platform migrations
- Previous experience in a startup or high-growth company environment
- Experience managing EDI clearinghouse relationships or trading partner onboarding