Health Plan Configuration Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Implement the configuration strategy and roadmap, converting vision into actionable objectives.

• Lead, develop, and expand a team of configuration and EDI analysts, encompassing hiring, mentoring, performance management, and succession planning.

• Collaborate with Product, Engineering, Operations, Finance, and leadership to align configuration capacity and priorities.

• Manage vendor relationships related to configuration, including SLAs, performance, and escalation processes.

• Create and maintain taxonomies for benefit categories, networks, plans, and configuration structures.

• Supervise technical support for claim loading, EDI transactions (837, 835, 278), and system troubleshooting.

• Oversee EDI trading partner and clearinghouse relationships while resolving transaction errors.

• Assist in the automation roadmap and implement efficiency and quality enhancements.

• Establish policies, controls, QA standards, documentation, and practices for audit compliance.

• Manage staffing and resource planning for the configuration function.

• Provide leadership with visibility into KPIs, risks, capacity, and performance trends.

• Coordinate cross-functionally during open enrollment, Q4, and system upgrades.

• Act as a senior subject matter expert on Gravie's claims system and configuration operations.

• Serve as the primary escalation point for intricate configuration and EDI issues.

⛳️ Requirements

• 6+ years of expertise in claims system subject matter.

• 3+ years of experience leading teams, team leads, or managers in a configuration, claims operations, or healthcare IT environment.

• Capability to function as a strategic partner to senior leadership and translate ambiguous directives into clear plans.

• Demonstrated ability to influence senior and executive stakeholders and drive organizational or process changes at scale.

• Strong executive presence, communication skills, and the ability to build cross-functional relationships.

• Experience managing budgets, vendor contracts, or SLAs, and making resource allocation decisions.

• Proficient in guiding teams through complex technical and configuration challenges.

• Ability to navigate ambiguity and take decisive actions.

• Excellent organizational, time management, and prioritization abilities.

• Familiarity with EDI transaction standards (837, 835, 834, 278) and their integration with claims configuration and adjudication.

• Experience in a regulated healthcare or health plan context is a plus.

• Experience in supporting system integrations or extensive platform migrations is a plus.

• Previous experience in a startup or rapidly growing company is a plus.

• Experience managing EDI clearinghouse relationships or trading partner onboarding is a plus.

• Must currently be authorized to work in the United States.

🏝️ Benefits

• Coverage for alternative medicine.

• Flexible paid time off (PTO).

• Up to 16 weeks of paid parental leave.

• Paid holidays.

• 401k program.

• Transportation perks.

• Education reimbursement.

• 2 days of paid paw-ternity leave.

• Standard health and wellness benefits.