QNXT Benefit Configuration Specialist — Healthcare Payer

Veriipro; New York (NY); On-site; USD 110,000 - 150,000; Full time

Job summary

Veriipro in New York seeks an experienced QNXT Benefit Configuration Analyst to support the implementation, enhancement, and maintenance of benefit plans within the TriZetto QNXT platform. The ideal candidate will translate business requirements into precise system configurations and collaborate with cross-functional teams to deliver compliant healthcare solutions.

The role requires deep knowledge of healthcare payer operations, benefit design, claims adjudication, SQL, and end-to-end testing,

Qualifications

• 5+ years of Healthcare Payer experience.
• 5+ years of hands-on TriZetto QNXT Benefit Configuration experience.
• Strong understanding of healthcare benefit design and claims adjudication.
• Experience configuring: Service Groups, Restriction Groups, Copay Groups, Coinsurance, Deductibles, MOOP, Visit Limits, Prior Authorization Rules, In-Network / Out-of-Network Benefits.
• Experience with Commercial, Medicare, and Medicaid benefit plans.

Responsibilities

• Configure and maintain benefit plans within the QNXT platform based on business and regulatory requirements.
• Configure Service Groups, Restriction Groups, Copay Groups, Coinsurance, Deductibles, MOOP, Accumulators, Visit Limits, Authorization Rules, and Benefit Limits.
• Analyze business requirements and translate them into detailed configuration specifications.
• Collaborate with Business Analysts, Product Owners, Configuration Analysts, Developers, QA, and Business Stakeholders.
• Perform impact analysis for new benefit changes, regulatory updates, and annual benefit plan implementations.
• Support annual benefit rollovers and Open Enrollment implementations.
• Validate benefit configurations using the QNXT Claims module to ensure claims adjudicate correctly.
• Develop configuration documentation, design documents, mapping documents, and implementation guides.
• Troubleshoot benefit configuration issues and identify root causes.
• Participate in release deployments and post-production validation activities.

Skills

Healthcare payer industry

QNXT configuration

SQL queries

End-to-end testing

Stakeholder communication

Tools

QNXT Configuration Studio

Configuration Migration Tool

Jira

Azure DevOps

Rally

Job description

Veriipro in New York seeks an experienced QNXT Benefit Configuration Analyst to support the implementation, enhancement, and maintenance of benefit plans within the TriZetto QNXT platform. The ideal candidate will translate business requirements into precise system configurations and collaborate with cross-functional teams to deliver compliant healthcare solutions.

The role requires deep knowledge of healthcare payer operations, benefit design, claims adjudication, SQL, and end-to-end testing,