Manager, Configuration

COMPANY OVERVIEW:

HealthAxis is a prominent provider of core administrative processing system (CAPS) technology, business process as a service (BPaaS), and business process outsourcing (BPO) capabilities to healthcare payers, risk-bearing providers, and third-party administrators. We are transforming the way healthcare is administered by providing innovative technology and services that uniquely solve critical healthcare payer challenges negatively impacting member and provider experiences.

We live and work with purpose, care about others, act with integrity, communicate with transparency, and don’t take ourselves too seriously.

We're not just about business – we're about people. Our commitment to a people-first approach shapes everything we do, from collaborating as a team to serving our valued clients. We believe that creating a vibrant and human-centric environment can inspire engagement, empower our team members, and ignite a sense of purpose in all that we accomplish.

PURPOSE AND SCOPE:

The Manager of Configuration is responsible for overseeing the configuration function within the health plan, ensuring that all systems and operational workflows related to benefits, fee schedules, pricing, testing, and claims payment are accurately set up and functioning as intended. This role supervises a team of configuration specialists and ensures that all configuration tasks are completed timely, accurately, and in compliance with applicable regulations and organizational policies. The Configuration Supervisor also collaborates with cross-functional teams to ensure seamless integration of configuration changes and system updates, supporting overall health plan operations and claims processing efficiency.

PRINCIPAL RESPONSIBILITIES AND DUTIES:

Supervise Configuration Team

• Lead, manage, and mentor a team of configuration specialists to ensure successful implementation and maintenance of all configuration-related tasks, including benefits setup, fee schedules, pricing, and testing.

• Oversee daily workflow, assign tasks, and provide guidance to team members to ensure accurate and timely completion of all configuration duties.

• Provide training, development, and performance feedback to the configuration team to enhance their skills and maintain high levels of performance.

• Foster a collaborative environment within the team and across other departments to achieve organizational goals and meet deadlines.

Configuration and System Setup

• Ensure accurate configuration of health plan benefits, fee schedules, pricing structures, and related parameters in the system.

• Oversee the configuration of complex benefits and claims-related setup, ensuring all elements are in alignment with organizational policies, contracts, and regulatory requirements.

• Manage the setup and maintenance of pricing models, including reimbursement rates, co-pays, deductibles, and out-of-pocket maximums.

• Ensure appropriate system setup for claims payment, ensuring accurate and efficient payment processing aligned with benefit structures and pricing models.

Testing and Quality Assurance

• Manage the testing and validation of configuration changes in the system to ensure they are working as intended and meet business requirements.

• Oversee UAT (User Acceptance Testing) for configuration-related updates and new system functionality, coordinating with IT and other departments to ensure successful testing and issue resolution.

• Review and address any discrepancies, errors, or issues identified during testing, collaborating with the IT department to resolve them quickly.

• Ensure all changes to the configuration are documented, tracked, and version-controlled to maintain accuracy and consistency in the system.

Collaboration and Stakeholder Engagement

• Work closely with other operational teams such as Claims, IT, Member Services, and Compliance to ensure accurate configuration and seamless integration of system changes.

• Serve as a liaison between the configuration team and business stakeholders to gather requirements, provide updates, and ensure alignment on configuration objectives.

• Collaborate with vendors or external parties when necessary to ensure that system configurations meet contractual or regulatory requirements.

Monitoring and Reporting

• Monitor configuration performance to ensure that all systems are working as expected and claims are processed accurately.

• Generate and review regular reports related to configuration performance, issues, and changes, providing insights and recommendations to senior leadership.

• Ensure that all configurations are compliant with contractual obligations, regulatory requirements, and internal policies.

Continuous Improvement

• Identify opportunities for process improvements and work with cross-functional teams to implement changes that enhance the accuracy, efficiency, and effectiveness of configuration processes.

• Stay informed of changes in healthcare regulations, industry standards, and best practices to ensure configuration processes remain up-to-date and compliant. 

• Lead initiatives to enhance the team's capabilities, processes, and tools to improve overall configuration quality and effectiveness.

 EDUCATION, EXPERIENCE AND REQUIRED SKILLS:

• Bachelor’s degree in Healthcare Administration, Business Administration, Information Technology, or a related field (required).

• Master’s degree in Healthcare Administration or Business Administration is preferred.

• Certification in Health Plan Administration, Configuration Management, or relevant IT certifications is a plus.

• Ongoing professional development in areas related to health plan configuration, claims processing, or IT systems management is encouraged.

• A minimum of eight years of health plan operations configuration is required.

Experience

• A minimum of 5 years of experience in health plan operations, with at least 2-3 years in a supervisory or leadership role in configuration or system setup within a health plan or managed care organization.

• Extensive experience with health plan benefits configuration, fee schedules, pricing models, and claims payment systems.

• Strong background in system testing, including User Acceptance Testing (UAT), and issue resolution related to system configuration.

• Experience in managing cross-functional teams, collaborating with IT, Claims, and other departments to ensure the accurate and timely setup of benefits and claims configurations.

• Proven track record in process improvement and identifying opportunities to enhance operational efficiency and quality.

Required Skills

• Strong leadership and people management skills, with the ability to supervise, motivate, and develop a team of configuration specialists.

• In-depth knowledge of health plan configuration processes, including benefits setup, pricing models, fee schedules, and claims payment systems.

• Proficiency in system testing and validation, including familiarity with UAT processes and defect tracking.

• Excellent communication and interpersonal skills to effectively collaborate with internal teams and external stakeholders.

• Strong analytical and problem-solving skills, with attention to detail and a focus on accuracy.

• Ability to manage multiple projects and competing priorities in a fast-paced environment.

• Proficiency with health plan management software, claims systems, and MS Office Suite (Excel, Word, PowerPoint).