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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