SME - QNXT Benefit Configuration

Job Requirement

Must have:

• 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

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.

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