Health Plan Configuration Manager
Core
Manage health plan configuration strategy and EDI operations for a claims system serving small and midsize businesses.
Role type
Manager of Health Plan Configuration
Builds
Configuration infrastructure and claims processing workflows for level-funded health plans
Domain
Healthcare / Health Insurance / Claims Operations
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure
Required skills
Claims system subject matter expertise, team leadership, strategic planning, vendor relationship management, EDI standards knowledge, process optimization, risk management, cross-functional collaboration
Preferred skills
Regulated healthcare environment experience, system integration experience, startup/high-growth environment experience, EDI clearinghouse management
Technologies
EDI (837, 835, 278, 834), X12 standards, claims systems
Responsibilities
Execute configuration strategy and roadmap, lead and scale a team of configuration and EDI analysts, partner with cross-functional stakeholders, manage vendor relationships and SLAs, develop benefit taxonomy, oversee technical support for claim loading and EDI transactions, support automation roadmap, establish QA standards and policies, manage staffing and resource planning, provide strategic input on KPIs and performance trends, lead cross-functional coordination during high-stakes periods
Seniority
Manager, hands-on leadership
