QNXT Benefit Configuration SME

We are actively seeking QNXT Benefit Configuration Subject Matter Experts (SMEs) with a strong background in both commercial and government benefit structures. The ideal candidate will have hands-on expertise in QNXT core modules and be proficient in benefit setup, configuration, claims validation, and data migration. This position plays a critical role in ensuring accurate benefit designs and seamless integration within QNXT environments.

Key Responsibilities:

• Configure and manage QNXT benefits during initial implementations and annual renewal cycles.
• Collaborate with internal and external teams to align benefit configuration with business and regulatory requirements.
• Perform gap analysis between client requirements and QNXT capabilities; recommend workarounds or customization where needed.
• Conduct offline configuration testing and assist with unit and integration testing.
• Leverage SQL to perform data validation, extract configuration data, and analyze claims/benefit structures.
• Troubleshoot benefit configuration issues and perform impact analysis for updates or changes.
• Execute mass updates, data conversions, and benefit mapping using QCS and CMT tools.
• Maintain documentation of configuration changes and ensure compliance with industry standards.

Required Skills & Qualifications:

• 3+ years of hands-on experience in QNXT benefit configuration.
• Deep understanding of commercial and government healthcare plan types: HMO, PPO, POS, ASO.
• Strong knowledge of benefit design, including:
  • Multi-tier copays
  • Service codes
  • Deductibles
  • Accumulators
• Proficiency in QNXT modules: Benefit Config, Claims, Enrollment, Authorization.
• Strong SQL skills for querying QNXT database structures (members, benefits, claims, plan data).
• Experience with QCS (QNXT Configuration System) and CMT (Configuration Management Tool).
• Ability to work independently, manage priorities, and collaborate with technical and business teams.

Nice to Have:

• Experience working in a payer or health plan environment.
• Familiarity with CMS guidelines and HIPAA compliance.
• Experience in Agile/Scrum environments.