[Hiring] Manager, Benefit Configuration Quality and Audit @Imagine360

Role Description

Imagine360 is seeking a Manager, Benefit Configuration Quality and Audit to join the team! The Manager, Benefit Configuration Quality and Audit is responsible for leading a team of Plan Build Auditors who validate US healthcare plan build configurations against approved plan documents, benefit matrices, configuration requirements, coding standards, and implementation guidelines.

• Lead, coach, and manage a team of Plan Build Auditors responsible for auditing medical, dental, and vision plan configuration for new groups, renewals, conversions, and benefit changes.
• Manage 7+ offshore contractors - including work allocation, communication cadence, productivity tracking, training support, and quality review across distributed teams.
• Establish consistent, repeatable, and auditable quality review processes for plan build configuration across all audit team members.
• Oversee audit workflows from preparation through defect documentation, retesting, closure, and final audit disposition.
• Monitor audit quality, defect trends, aging items, reopened defects, QA rejection rates, and recurring configuration errors across the team.
• Develop training materials, onboarding plans, calibration sessions, and knowledge-sharing routines to improve auditor consistency and domain expertise.
• Review and validate audit coverage across plan-level fields, benefit-level configuration, accumulators, deductible and out-of-pocket logic, copay, coinsurance, network tiers, exclusions, authorizations, limitations, COB, and QPA methodology.
• Ensure auditors validate configuration against approved source documents including plan documents, benefit matrices, mapping legends, best practice sheets, coding direction, validation guidance, vendor sheets, fact sheets, and division tables.
• Demonstrate strong ability to read, interpret, and summarize lengthy healthcare plan documents, benefit booklets, SPDs, SBCs, amendments, and client-specific benefit requirements to identify configuration impacts, gaps, exclusions, limitations, and testing scenarios.
• Define audit standards, checklists, quality metrics, reporting cadence, escalation paths, and governance routines to ensure consistency and accountability.
• Lead root cause analysis for configuration defects and drive corrective and preventive actions to improve first-pass quality.
• Build repeatable audit processes, training materials, checklists, dashboards, and governance routines to improve consistency, accountability, and quality outcomes.
• Support claims testing validation by ensuring configuration logic aligns with expected adjudication outcomes including deductible, OOP, coinsurance, accumulator, authorization, maximum, and benefit logic.
• Ensure audit validation includes eligibility, member data, accumulator inbound/outbound processing, claims data flows, and file-based data exchange impacts where applicable.
• Partner with Plan Build, Business Operations, Product, and vendor teams to resolve questions, clarify requirements, and prevent downstream production issues.
• Prepare executive-ready quality reporting including audit progress, risks, defect themes, SLA adherence, quality trends, and recommendations.
• Build dashboards, audit trackers, defect trend reporting, SLA metrics, and leadership scorecards for visibility and governance.
• Excellent written and verbal communication skills with the ability to present risks, quality trends, and recommendations to business, technical, vendor, and leadership stakeholders.

Qualifications

• Bachelor's degree in healthcare administration, Business Administration, Information Systems, Computer Science, Quality Assurance, or a related field required; equivalent healthcare payer, TPA, plan build, configuration, audit, or QA leadership experience may be considered.
• 10+ years of experience in US healthcare payer, TPA, benefits administration, plan build, benefit configuration, claims, eligibility, accumulator processing, data validation, or quality assurance functions.
• 5+ years of experience leading, mentoring, or supervising QA, audit, implementation, configuration, plan build, or operations teams.
• Hands-on experience leading and managing a team of 10+ Plan Build Builders and Auditors, including workload planning, quality oversight, performance coaching, audit calibration, and delivery accountability.
• Experience managing offshore resources, including work allocation, communication cadence, productivity tracking, training support, and quality review across distributed teams, is preferred.
• Experience reading, interpreting, and translating complex healthcare plan documents, SPDs, SBCs, amendments, and benefit summaries into audit criteria, configuration validation points, and testing scenarios.
• Experience with healthcare platforms, SQL/data validation, defect management, audit documentation, root cause analysis, process improvement, and executive-level reporting preferred.

Requirements

• Experience managing offshore resources, including work allocation, communication cadence, productivity tracking, training support, and quality review across distributed teams.
• Experience with healthcare platforms and tools such as VBA, Facets, CPBRE, IMPACT, Mainframe, MITS, PEX, Teradata, Denodo, TOAD, SQL Plus or similar systems.
• Experience supporting self-funded, TPA, payer, or benefits administration environments.
• Experience building dashboards, audit trackers, defect trend reporting, SLA metrics, or leadership scorecards.
• Experience creating SOPs, audit checklists, training materials, onboarding plans, calibration sessions, and process governance documentation.
• Certifications in quality assurance, process improvement, healthcare operations, or are a plus.

Benefits

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start/10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives