Senior Manager, Strategic Configuration

About the role

We are seeking a Senior Manager, Strategic Configuration to lead the enhancement of first-pass claim payment accuracy. This role focuses on ensuring claims are paid correctly and precisely the first time, requiring a blend of technical expertise and strategic vision.

Responsibilities

• Lead the technical design and implementation of strategic configuration logic to ensure flawless first-pass adjudication.
• Identify and address configuration gaps by optimizing edit logic and implementing enhanced precision-based review triggers to ensure payment precision at the point of initial intake.
• Evolve automated solutions to improve efficiency and accuracy in plan configuration, utilizing data-forward strategies to analyze configuration data and identify trends.
• Act as the primary strategic bridge between Configuration, Payment Integrity, Clinical Review, and Compliance, ensuring that plan designs and regulatory requirements are translated into actionable, high-precision configuration logic.
• Provide hands-on, "player-coach" leadership for a small, high-impact team of specialists, fostering a culture of excellence, accountability, and continuous technical learning.
• Develop best practices and documentation for advanced configuration procedures.

Requirements

• 7+ years of experience in Medicare Advantage or healthcare plan configuration, with at least 3 years in a leadership or managerial role.
• "In the weeds" expertise in technical configuration, specifically regarding complex provider contracts, clinical edits, and general reimbursement logic.
• Proficiency in health plan systems such as HealthEdge HRP and Source.
• Strong project management and problem-solving abilities with a proven track record of driving systemic process improvements.
• Passion for leveraging technology and data-driven insights to drive operational precision.
• Excellent verbal and written communication skills with the ability to translate complex technical concepts for diverse stakeholders.

Qualifications

• Passionate about improving the health of members through technology and data-driven insights.
• Experience in healthcare plan configuration, with a focus on Medicare Advantage.
• Technical expertise in configuring complex provider contracts, clinical edits, and reimbursement rules.
• Strong project management and problem-solving skills.
• Ability to communicate complex technical concepts clearly to diverse stakeholders.

Skills

• Strategic thinking and problem-solving skills.
• Technical proficiency in health plan systems.
• Leadership and team management skills.
• Communication and stakeholder engagement skills.

Benefits

• Financial Well-Being: Competitive base salary, performance-based bonus program, 401k matching, and regular compensation reviews.
• Physical Well-Being: Comprehensive medical, dental, and vision coverage.
• Mental Well-Being: Initiatives such as No-Meeting Fridays, company holidays, access to mental health resources, and a generous flexible time-off policy.
• Professional Development: Learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
• Additional Perks: Employee Stock Purchase Plan (ESPP), reimbursement for office setup expenses, monthly cell phone & internet stipend, remote-first culture, paid parental leave for all new parents, and much more!

Pay

A reasonable estimate of the base salary range for this role is $129,000 - $168,000 USD.

Schedule

Remote-first culture, enabling collaboration with global teams.