100% Remote – QNXT Accumulator SME

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NOTE: This is a 100% Remote position. EST working hours.

QNXT Accumulator SME (Claims / Enrollment / Configuration)

Overview

Seeking a highly analytical QNXT Accumulator Subject Matter Expert (SME) to support complex accumulator configuration, maintenance, troubleshooting, and claims analysis within a healthcare payer environment. This role requires deep expertise in how accumulators interact with claims adjudication, enrollment data, and benefit structures, along with the ability to investigate and resolve end-to-end processing issues across multiple systems and data layers.

Must Haves

• 5+ years of hands-on experience as a Subject Matter Expert (SME) supporting QNXT accumulators
• Strong expertise in accumulator configuration, maintenance, troubleshooting, and issue resolution
• Deep working knowledge of QNXT backend functionality, including writing and interpreting SQL queries
• Strong understanding of healthcare claims processing and adjudication workflows
• Experience supporting enrollment data, membership tables, and accumulator-related updates within enrollment systems
• Ability to perform end-to-end analysis across claims, accumulators, and enrollment data to identify root causes and downstream impacts
• Strong analytical, troubleshooting, and problem-solving skills
• Ability to work independently in complex, fast-paced production environments

Nice to Have

• Experience with benefit configuration and eligibility processing
• Exposure to Facets or other healthcare payer platforms
• Experience supporting production incidents, defect analysis, and operational support teams
• Knowledge of healthcare payer operations, deductibles, out-of-pocket maximums, and benefit accumulation logic
• Experience working with reporting, audit validation, or data reconciliation processes

Responsibilities

• Serve as the Subject Matter Expert for QNXT accumulators, including configuration, maintenance, troubleshooting, and operational support
• Analyze accumulator-related claim issues and determine impacts across claims processing and enrollment data
• Investigate complex production issues involving claim adjudication, accumulator balances, and member eligibility
• Write and interpret SQL queries to analyze backend data, validate accumulator behavior, and troubleshoot discrepancies
• Support enrollment-related accumulator updates and ensure data integrity across membership tables
• Perform root cause analysis and coordinate resolution efforts across business and technical teams
• Validate accumulator functionality during system updates, configuration changes, and defect remediation efforts
• Partner with claims, enrollment, configuration, and IT teams to improve operational accuracy and processing efficiency
• Document findings, issue resolution steps, and operational procedures to support audit readiness and knowledge sharing

Preferred Background

• Healthcare payer environment
• Claims operations or claims systems support
• QNXT configuration or production support teams
• Enrollment and benefits administration environments

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

NS-QNXTASMES-NS_1778612457

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