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NOTE: This is a 100% remote position. Candidates will be working on EST Timezone.

One of our clients is looking for a QNXT Benefits SME with the following skills and experience.

Job Description:

Seeking a QNXT Benefits Configuration Subject Matter Expert (SME) to join our team, focusing on end-to-end benefits configuration within QNXT. This role will involve designing and implementing benefit plans, gathering business requirements, and collaborating with stakeholders to ensure accurate configuration and compliance. The ideal candidate will have deep expertise in QNXT benefits, experience across commercial and government healthcare programs, and the ability to work with both front-end and back-end systems.

Key Responsibilities:

• Lead the configuration of benefit plans within QNXT, ensuring compliance with state, federal, and commercial requirements.
• Work with front-end QNXT benefits configuration (with experience in both front-end and back-end systems), focusing on ensuring accuracy and alignment with business requirements.
• Collaborate with internal teams and external stakeholders to gather, analyze, and design benefits configurations based on requirements.
• Leverage SQL expertise to write queries and validate configurations within QNXT.
• Provide leadership in designing benefit configurations, ensuring seamless integration with other system components.
• Play a critical role in migration and implementation projects, guiding the configuration and testing of benefits during system transitions.
• Understand and manage the full claims lifecycle, ensuring benefits configurations align with claim adjudication requirements.

Must-Haves:

• Expertise in QNXT benefits configuration (not just claims) with in-depth knowledge of front-end and back-end systems.
• At least 75% commercial and 25% Medicare/Medicaid experience in benefits configuration.
• Strong SQL experience, including the ability to write queries for validating benefits configuration data.
• Experience in designing benefits and translating business requirements into system configurations.
• Significant experience in front-end configuration within QNXT, including MOOP and benefit edits.

Preferred Qualifications:

• Hands-on experience with migration and implementation projects, particularly with QNXT.
• Familiarity with Service Groups and configuring benefits within front-end screens.
• Ability to understand and configure MOOP (Maximum Out-of-Pocket) and related benefit rules.
• Experience in gathering requirements and designing benefit configurations from scratch, working closely with clients to absorb and design based on their needs.
• Strong problem-solving and scenario-based thinking skills for addressing complex benefit configuration issues.

Interested candidates may submit their resumes online or call at 310-906-4780 for further information regarding the position.

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