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
Official Job Description:
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.
Key Responsibilities:
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
Qualifications:
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
