QNXT Benefit Configuration SME

Skills

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.

Description

QNXT Benefit Configuration SMEs with emphasis on commercial plans and Member, Claims, Provider, Sponsor, Benefit modules and related reference Tables.

Responsibilities

• 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.