Qnxt Claims Processing Jobs (NOW HIRING)

Our client, a IT Services and Consulting company, is looking for a QNXT Medical Claims Processor (Healthcare BPO) for their Phoenix, AZ location.
Responsibilities:

• Review incoming medical claims on the QNXT platform and validate member details provider information and policy coverage to ensure accurate claim setup and processing
• Process claims for medical services by applying payer rules benefit plans and contract terms to support accurate adjudication and payment decisions
• Verify coding consistency for diagnoses procedures and modifiers using provided references to minimize claim errors denials and rework -Identify discrepancies or missing information in claim submissions and coordinate with internal teams to obtain clarifications and ensure timely resolution
• Apply established business rules service level agreements and compliance guidelines during claim evaluation to maintain regulatory adherence and client satisfaction
• Monitor daily claim queues within the workflow system prioritize tasks based on urgency and volume and complete assignments within defined turnaround times
• Perform quality checks on processed claims using predefined audit checklists to detect defects implement corrective actions and support continuous improvement
• Document all actions taken on claims in the system with clear concise and audit ready notes to maintain traceability and support future reviews
• Collaborate with quality and training teams by sharing recurring issues or knowledge gaps observed in claims to help refine process documentation and training content
• Respond to queries from internal stakeholders regarding claim status policy interpretation or processing logic while maintaining a professional and customer focused approach
• Contribute to process improvement ideas by highlighting patterns in denials rework or system defects that impact productivity and suggesting practical solutions
• Adhere to day shift schedules work from office guidelines and security protocols to maintain data confidentiality and a stable operational environment without travel requirements
• Support team performance goals by maintaining personal productivity accuracy and attendance standards thereby contributing to the overall success of client healthcare operations and member satisfaction

• Demonstrate hands on experience or training in QNXT claims processing for medical lines of business including familiarity with core claim adjudication workflows and navigation
• Possess foundational knowledge of health insurance concepts such as eligibility benefits copay coinsurance deductibles and coordination of benefits to interpret claim scenarios effectively
• Show understanding of medical billing components including procedure codes diagnosis codes and basic utilization management indicators sufficient for accurate data validation
• Bring experience from BPO healthcare or back office operations where processing accuracy volume handling and adherence to service targets were critical performance measures
• Exhibit strong analytical and problem solving skills to investigate claim issues identify root causes and apply appropriate resolutions without extensive supervision
• Demonstrate proficiency in using office productivity tools and workflow applications to manage queues update records and communicate with stakeholders in a structured manner Communicate clearly in spoken and written form to document claim actions escalate issues and collaborate with team members and supervisors in a professional setting
• Display flexibility to adapt to updated payer rules process changes and system enhancements with a willingness to learn and participate in refresher trainings as required
• Prefer candidates who have exposure to quality frameworks or metrics driven environments where defect rates turnaround time and customer satisfaction were actively monitored
• Prefer candidates who show strong attention to detail time management discipline and an ethical approach to handling sensitive health information in a work from office setting
• Preferred certifications in healthcare such as Certified Professional Coder CPC or equivalent medical claims processing credentials.
• 3.00 Years of Experience

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities