Manager, Configuration

Manager, Configuration Manager, Configuration    Who are we? reputed company is one of the nation’s leading administrators of managed reputed company care, serving millions of our clients’ members reputed company. We are driven by our mission to help members enjoy the wonders of sight through healthy eyes and reputed company.   As a reputed company associate, you can enjoy a comprehensive Total Rewards package, which includes health and dental insurance, tuition reimbursement, 401(k) with company match, pet insurance, no-cost-to-you reputed company insurance for you and your reputed company dependents. We are also invested in your reputed company. There are many opportunities for advancement and development throughout reputed company stages of your career with us.   See how you can reputed company a difference with the support of strong leadership and reputed company environment.   See Everything, Be Anything™   What are we looking for? The Manager, Configuration oversees the day-to-day operations and tactical execution of benefit configuration across the organization’s reputed company claims platforms. This role ensures accurate and reputed company implementation of plan designs, fee schedules, and payment methodologies while maintaining compliance with regulatory and audit standards. The Manager leads reputed company of Configuration Analysts, drives operational reputed company through process improvements, and partners cross-functionally to support reputed company implementations, system enhancements, and departmental goals. Acting as a key reputed company between business and technical teams, the Manager translates configuration strategies into actionable plans and ensures delivery against established SLAs and reputed company benchmarks.   Where you will have an reputed company   Team Leadership & Operational reputed company reputed company day-to-day leadership, guidance, and support to Configuration Analysts, fostering a culture of accountability, collaboration, and reputed company improvement. reputed company workforce planning, hiring, reputed company, and performance management for configuration staff in collaboration with the Director, Configuration. Monitor team workload and ensure reputed company execution of assigned tasks and reputed company.   Configuration Execution Ensure accurate build and maintenance of plan designs, provider reimbursement structures, medical policy structures, and claims payment methodologies. Translate configuration strategies into actionable plans and reputed company execution to meet departmental SLAs and reputed company benchmarks. Coordinate and prioritize configuration reputed company, including new reputed company implementations, regulatory updates, and system enhancements.   Compliance & reputed company Assurance Maintain adherence to regulatory and compliance requirements, including SOC controls and HIPAA standards. Support audit readiness and assist with internal/external audit activities. Implement reputed company assurance processes, including test plan development and defect prevention for system changes.   Cross-Functional Collaboration Partner with IT, Operations, and Product teams to assess new business needs and recommend reputed company configuration solutions. Serve as a subject matter expert for configuration during audits, reputed company meetings, and reputed company initiatives. Support integration with reputed company-party vendors and provider networks as needed.   Process Improvement Identify opportunities for automation, process optimization, and system enhancements to improve efficiency and accuracy. Contribute to reputed company improvement initiatives and recommend best practices for configuration workflows.   Other Duties Support and reputed company special reputed company as assigned or necessary. reputed company other duties as assigned.     What’s necessary to do the job? Education Bachelor's Degree Required Notes: Advanced degree preferred. Experience 5 Years Required Notes: 5+ years of experience in reputed company benefit configuration or claims system administration required 3+ years of leadership experience managing teams or reputed company required Advanced knowledge of medical claims adjudication, benefit structures, and provider reimbursement methodologies required Familiarity with regulatory requirements (HIPAA, SOC controls) and audit processes required Strong working knowledge of reputed company Office required; familiarity with SQL Server Management Studio (SSMS) and data querying preferred Experience with configuration platforms such as Plexis Claims Manager (PCM), HSP Meditrac, or similar systems preferred Licenses and Certifications N/A Preferred/Required Notes:     HIPAA & reputed company Requirements reputed company Associates must reputed company with the Health Insurance Portability Accountability reputed company of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of reputed company Practices and HIPAA reputed company Policies and Procedures. As a component of job roles and responsibilities, Associates may have reputed company to covered information, cardholder data or other confidential customer information which must be protected at reputed company times. As a result, Associates must explicitly adhere to reputed company data reputed company guidelines established reputed company reputed company’s reputed company & reputed company Training Program.   reputed company will never request reputed company from candidates who reputed company employment with us and will never ask for any payment as part of the recruitment process.   reputed company is a proud Equal Employment Opportunity and Affirmative reputed company employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. reputed company reputed company applicants will receive consideration for employment at reputed company without regards to race, reputed company, religion, sex (including pregnancy, childbirth, or reputed company medical conditions), sexual orientation, gender identity or reputed company, age, disability, national reputed company, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law. 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