QNXT Benefit Configuration SME

  • Posted 34 days ago | Updated 13 days ago

Overview

Remote
Depends on Experience
Full Time

Skills

QNXT
Design documentation
Design
Optimization
Data
Performance tuning
Authorization
Experience design
Analytical skill
Facilitation

Job Details

Role: QNXT Benefit Configuration SME

Location: Virginia Beach, VA (Remote)

Responsibilities

QNXT Benefit Configuration SMEs with emphasis on commercial plans and Member, Claims, Provider, Sponsor, Benefit modules and related reference Tables.

Scope of the Need:

  • The resources will support Benefit Configuration, data formatting, validation, unit testing, and error remediation.
  • The Benefit Configuration Analyst SME would be collaborating with stakeholders to gather, assess, interpret, and design/document Benefit configuration needs and coverage requirements.
  • Analysts must lead communications and facilitation efforts to present the documented findings and results from an analytical engagement.
  • The analysts must have the ability to independently analyze or mine data, draw sound conclusions, and is able to interpret detail plan benefit summaries
  • Analysts must diligently follow written instructions, oral instructions, and policy.

Experience Necessary:

  • 3-5 Years of QNXT Benefit Configuration Implementation and Support Experience (Design, configuration, front/back-end load configuration, resolution/update)
  • Independently design, configure and build benefit plans and various benefit components in QNXT
  • Expertise in setting up and maintaining benefit plan hierarchies, including base plans, riders, and their attributes. This includes understanding the financial impact of benefit configurations on plan costs and premiums.
  • Deep knowledge of Claims Processing Lifecycle - Including the upstream/downstream processes that impact claims payment
  • Independently research claims issues to determine benefit configuration gaps, update configuration as applicable.
  • Exposure and demonstrated ability to create / maintain UM Authorization Templates
  • 3-5 Years experience of a demonstrated ability to independently create intermediate SQL queries - above and beyond basic.
  • Ability to rapidly interpret and understand current data schemas that are new an unfamiliar
  • Proven ability to operate in complex projects related to benefit configuration, including the ability to lead cross-functional teams and manage timelines, resources, and deliverables effectively.
  • Demonstrated experience in identifying, diagnosing, and resolving complex issues related to benefit configuration in QNXT, including performance tuning and system optimization.
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