Overview:
We are seeking experienced QNXT Configuration Specialists to support a large-scale implementation project involving the addition of 20 new plans and over 1,000 provider contracts to the QNXT platform. These roles will also support the buildout of 95 Medicare Plan Benefit Packages (PBPs) for 2026. Candidates with strong commercial or marketplace experience, and deep Medicare configuration expertise, are highly encouraged to apply.

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Key Responsibilities:

Commercial/Marketplace Workstream:

• Interpret complex paper contracts for provider reimbursement terms and conditions.
• Review and analyze benefit forms, cost-share structures, and EOC (Explanation of Coverage) documents.
• Collaborate with the Benefit Interpretation Team to convert documentation into structured system requirements.
• Configure benefits and reimbursement logic in QNXT and NetworX modules.
• Apply cautionary reduction functionality where appropriate to ensure accurate reimbursement.
• Support the setup of over 1,000 provider contracts and 20+ new health plans.

Medicare Workstream:

• Partner directly with client Medicare teams to configure 95 new PBPs for 2026.
• Use QNXT backend capabilities to run queries and validate configuration inputs.
• Leverage QCS and QNXT COB functionality to ensure compliance and accuracy of Medicare benefit design.
• Evaluate and load cost share and benefit data based on Medicare source documentation and regulatory requirements.
• Perform side-by-side validation with internal and client teams.

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Required Skills & Experience:

• 3+ years of hands-on experience with QNXT configuration (Commercial or Medicare).
• Strong knowledge of NetworX configuration and provider contract setup (Commercial).
• Experience interpreting paper contracts, benefit forms, and EOC documents.
• Deep understanding of Medicare PBPs, Cost Share, QCS, COB functionality, and QNXT backend queries.
• Ability to translate complex requirements into system configurations with high attention to detail.

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Preferred Qualifications:

• Prior experience supporting large-scale plan builds or system migrations in a health payer setting.
• Familiarity with state marketplace or commercial exchange plans.
• Strong SQL skills to support backend queries and data validation in QNXT.

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To Apply:
Please submit your resume highlighting your QNXT configuration experience in both Commercial and/or Medicare domains. Immediate interviews available for qualified candidates.