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Full Time Qnxt Jobs (NOW HIRING)

1199SEIU Funds

Quality Control Reviewer III

New York, NY · On-site

$50K - $64K/yr

Requisition #: 7512 # of openings: 1 Employment Type: Full time Position Status: Permanent Category ... Fund policies and contracted/repricing rates • Conduct system testing as it relates to QNXT ...

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Full Time Qnxt information

What is a full time QNXT?

A Full Time QNXT job typically refers to a position where an employee works with the QNXT software system, which is a healthcare payer core administration platform developed by TriZetto. Professionals in these roles may be responsible for configuring, maintaining, or supporting QNXT for health insurance companies, focusing on claims processing, member management, and provider data. Full-time QNXT jobs can include roles like QNXT Analysts, Developers, Business Analysts, and Support Specialists. These positions generally require knowledge of healthcare processes, experience with QNXT, and problem-solving skills. Working full-time means a standard workweek, often with benefits and long-term employment.

What are some common challenges faced by full time QNXT professionals when managing complex healthcare claims?

Full Time QNXT professionals often encounter challenges such as navigating intricate claims data, adapting to frequent regulatory updates, and ensuring data accuracy while processing high volumes of transactions. Collaboration with IT, clinical, and business teams is essential to resolve system issues and streamline workflows. To succeed, professionals must stay current with QNXT system enhancements and industry best practices, which helps ensure compliance and operational efficiency.

What are the key skills and qualifications needed to thrive as a full time QNXT analyst, and why are they important?

To thrive as a Full Time QNXT Analyst, you need a solid understanding of healthcare claims processing, benefit configuration, and experience with the QNXT platform, often supported by a degree in healthcare administration or a related field. Proficiency with QNXT software, SQL, and knowledge of related systems like EDI and HIPAA compliance is typically required. Strong problem-solving abilities, attention to detail, and effective communication are important soft skills in this role. These competencies ensure accurate claims processing, regulatory compliance, and collaboration across teams for efficient healthcare operations.

What is the difference between Full Time Qnxt vs Health Insurance Claims Processor?

AspectFull Time QnxtHealth Insurance Claims Processor
CredentialsTypically requires knowledge of Qnxt software, healthcare billing, and coding certificationsRequires understanding of insurance policies, billing, and coding, often with similar certifications
Work EnvironmentOffice-based, healthcare or insurance company settings, involving software use and data managementOffice or remote, handling claims data, customer interactions, and billing processing
Industry UsagePrimarily in healthcare administration, insurance companies, and third-party administratorsIn healthcare insurance companies, hospitals, and billing services

Full Time Qnxt roles focus on managing healthcare data using the Qnxt platform, requiring specific software knowledge and certifications. Health Insurance Claims Processors handle claims and billing, often with overlapping skills. Both roles are essential in healthcare administration but differ mainly in software specialization and daily tasks.

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What are the most commonly searched types of Qnxt jobs?

The most popular types of Qnxt jobs are:

What job categories do people searching Full Time Qnxt jobs look for?

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Full Time Qnxt jobs near you
Infographic showing various Full Time Qnxt job openings in the United States as of August 2026, with employment types broken down into 84% Full Time, and 16% Contract. Highlights an 50% Physical, 2% Hybrid, and 48% Remote job distribution.

Quality Control Reviewer III

1199 Seiu National Benefit Fund

Manhattan, NY • On-site

$50K - $64K/yr

Full-time

Re-posted yesterday

Job description

Requisition #:
7512
# of openings:
1
Employment Type:
Full time
Position Status:
Permanent
Category:
Bargaining
Workplace Arrangement:
Hybrid
Fund:
1199SEIU National Benefit Fund
Job Classification:
Non-Exempt
Responsibilities
• Cross train Processors and Quality Control Reviewers in the Hospital Claims Department
• Create advances from providers based on the findings of the Fraud & Abuse Department
• Review complex claim issues involving 1st, 2nd and 3rd level (IPRO) appeals
• Review and finalize claims according to Ceris findings
• Monitor claims processing system (QNXT) to ensure functionality of Hospital claims processing (i.e electronic, imaging, eligibility downloads from V3, pricing verification and pay-to-assignments)
• Review and handle ESI/ eviCore corrected claim reports
• Review and correspond with Aetna P.O.S on specific requests
• Ensure timely/accurate processing of hospital claims according to Claims Xten, Lab Management, Radiation Therapy, High-End Imaging, Medical Oncology and Specialty drug programs (i.e eviCore and CareContinuum); Summary Plan Description (SPD) guidelines, member benefits/eligibility parameters pre-authorization requirements; Fund policies and contracted/repricing rates
• Conduct system testing as it relates to QNXT upgrades, system enhancements and review performance of automated software
• Review Document Management System (DMS) inquiries/reconsiderations/medical records for accuracy, claims spreadsheets and determine action needed to rectify and resolve claims
• Process and evaluate facility claims manually or through DMS
• Respond in writing to provider inquiries/reconsiderations regarding claim adjustments/denials
• Resolve call tracking tickets and escalated e-mails in a timely manner
• Perform adjustments (related to inquiries, MedReview focused/revised DRGs Care Allies retrospective determinations); request credit refunds from provider and members; update member/claim memos regarding payment adjustments (overpayments and refunds)
• Request refunds for erroneous payments from providers and members
• Apply overpayments and refunds received and reported by the Claims Quality Assurance Department
• Perform additional duties and projects as assigned by management
Qualifications
• High School Diploma or GED required, some College or Degree preferred
• Minimum (3) three years hospital claims processing required
• Strong knowledge of eligibility system, Coordination of Benefits (COB) guidelines and hospital claims processing required
• Intermediate knowledge of Microsoft Excel required; MS Word preferred
• Excellent communication skills both oral and written required; able to initiate correspondence and respond to inquiries in a clear and professional manner
• Ability to prioritize and work under pressure, with strict timelines and target dates
• Strong organizational and analytical skills with the ability to multi-task and follow up
• Good problem-solving skills with the ability to work independently and be a team player

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