Lead Analyst QNXT

Overview

Remote

$80,000+

Full Time

Skills

Medicaid

Claims Management

Collaboration

Communication

QNXT

Recovery

Regulatory Compliance

Electronic Data Interchange

FOCUS

Root Cause Analysis

Auditing

Mentorship

Pricing

Process Improvement

Reporting

Research

Sales

Testing

SQL

SOP

Job Details

Job Title: Lead Analyst Configuration Oversight

Location: Remote | Domain: Healthcare

No 3rd aprty or bench sales .

Job Summary:

One of our Healthcare Parner is seeking a Lead Analyst Configuration Oversight to ensure accuracy and compliance in Medicaid Coordination of Benefits (COB) claim pricing and processing. This role supports Payment Integrity and Claims Operations, with a strong focus on identifying over/underpayments, validating configuration rules, and ensuring regulatory alignment.

Key Responsibilities:

Review and audit Medicaid COB claims for accurate secondary pricing logic.
Analyze claim trends and discrepancies; conduct root cause analysis.
Use QNXT to research claims history, provider contracts, and configuration.
Collaborate across Configuration, Claims, and Payment Integrity teams.
Serve as a subject matter expert in COB claim adjudication and configuration.
Support internal audits, SOP development, and regulatory compliance.
Mentor junior analysts and contribute to configuration/testing standards.
Pull and analyze data using SQL for audit and reporting purposes.
Write clear requirements for BRDs/FRDs and lead configuration projects end-to-end.

Required Qualifications:

Associate s degree or equivalent experience.
7+ years in claims auditing, operations, or regulatory oversight.
Strong experience with QNXT, COB, Medicaid claims, and provider contracts.
Proficiency in MS Office and SQL; strong communication skills.
Experience leading or mentoring teams; process improvement exposure.

Preferred Qualifications:

Bachelor s degree.
Background in Payment Integrity, EDI (837/835), or Medicaid recovery audits.

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