QNXT Benefit Configuration SME

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.