QXNT Benefit Configuration SME

This is a remote position.

Location : Remote

• Solid knowledge of commercial, Government benefit structures and plan designs ( HMO, PPO, POS, ASO etc.)
  
• Expertise in QNXT core modules Benefit Config, Claims, Enrollment, authorization
  
• Configure and test benefits offline during initial setup or annual renewal cycles
  
• Proficient in benefit design to include multi-tier copay, service codes, copays, deductibles, and accumulator
  
• Data migration/conversion/mapping/benefit configuration mass updates
  
• Perform gap analysis between client needs and QNXT capabilities; recommend system workarounds or custom solutions.
  
• Intermediate to advance SQL queries for validation, configuration analysis and QNXT db structures for member, benefit, claims, plandata etc.
  
• Ability to troubleshoot benefit configuration edits, validate claims and conduct unit, integration testing
  
• Proficient in QCS and CMT Tool
  

• We are seeking a skilled QNXT Benefits Configuration Specialist to join our dynamic team. The ideal candidate will possess in-depth knowledge of QNXT benefits configuration, along with a strong background in both commercial and government benefit claims. This role is critical for ensuring our benefits systems are accurately designed and configured to meet our organizational needs.
  

• Configure and manage QNXT benefits, ensuring comprehensive understanding of the platform’s capabilities and intricacies.
  
• Collaborate with cross-functional teams to design and implement benefits configurations that align with business requirements.
  
• Analyze and process commercial and government benefit claims, providing expertise on best practices and compliance.
  
• Write, troubleshoot, and optimize SQL queries to extract and analyze data related to benefits configurations and claims processing.
  
• Serve as a subject matter expert in front-end configuration, ensuring user-friendly interfaces that enhance the user experience.
  
• Document benefits configuration processes and maintain up-to-date knowledge of industry trends and regulatory changes.
  

Requirements

• Proven experience with QNXT benefits configuration (specific to benefits, not just claims).
  
• Solid understanding of commercial and government benefit claims processes.
  
• Proficiency in SQL with experience in writing and optimizing queries.
  
• Strong experience in designing benefits configurations, with an emphasis on accuracy and compliance
  
• Excellent communication and collaboration skills, with the ability to work effectively in a team environment.
  
• Detail-oriented and analytical mindset, with strong problem-solving abilities