Senior Manager of Strategic Configuration

Job Summary

Leading a specialized team in a remote setting, the full-time Senior Manager of Strategic Configuration will enhance first-pass claim payment accuracy by optimizing technical configuration, refining edit logic, and implementing automated solutions to ensure precise adjudication in the Medicare Advantage space.

Key responsibilities:

• Lead the technical design and implementation of strategic configuration logic for flawless first-pass adjudication
• Identify and address configuration gaps by optimizing edit logic and implementing precision-based review triggers
• Act as the primary strategic bridge between Configuration, Payment Integrity, Clinical Review, and Compliance to ensure accurate configuration logic

Required qualifications:

• 7+ years of experience in Medicare Advantage or healthcare plan configuration, with at least 3 years in a leadership role
• Expertise in technical configuration related to complex provider contracts, clinical edits, and reimbursement logic
• Proficiency in health plan systems such as HealthEdge HRP and Source
• Strong project management skills with a proven track record of driving systemic process improvements
• Passion for leveraging technology and data-driven insights to enhance operational precision