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Qnxt Claims Processing Jobs (NOW HIRING)

APWU AFL-CIO HEALTH PLAN

TEST ENGINEER

Elkridge, MD · On-site

Primarily focusing on testing and validation for upgrades, add-ons, benefit changes and continued maintenance of the QNXT claims processing system. * Testing and validation of all business-related ...

E-Pro

Business Analyst - QNXT Platform

Baltimore, MD · On-site

... claims processing, enrollment processing, premium billing, provider contracts or benefits administration desirable. • QNXT configuration experience required on version 4.8 or later. • Possesses ...

1199SEIU Funds

Hospital Claims Processor V

Manhattan, NY · On-site

$18.75 - $23.75/hr

Validate information entered in hospital claims module (QNXT); determine the process or work flow needed to resolve discrepancies * Finalize hospital claims by applying knowledge of eligibility ...

1199SEIU Funds

Hospital Claims Processor V

Manhattan, NY

$18.75 - $23.75/hr

Validate information entered in hospital claims module (QNXT); determine the process or work flow needed to resolve discrepancies * Finalize hospital claims by applying knowledge of eligibility ...

TEKsystems

Claims Operations Manager

Honolulu, HI

$30 - $32/hr

This role ensures accurate, timely adjudication of claims, drives process improvements, and manages ... e.g., QNXT, Facets, or similar platforms) - Experience working with third-party vendors or ...

TEKsystems

Claims Operations Manager

Honolulu, HI

$30 - $32/hr

This role ensures accurate, timely adjudication of claims, drives process improvements, and manages ... e.g., QNXT, Facets, or similar platforms) - Experience working with third-party vendors or ...

1199SEIU Funds

Chief Clerk III

Manhattan, NY

Maintain accurate data entry of 199SEIU member information in hospital claims processing system (QNXT) Track and ensure completeness of daily inquires; ensure they are sent to appropriate payment ...

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How much do qnxt claims processing jobs pay per hour?

As of Jun 10, 2026, the average hourly pay for qnxt claims processing in the United States is $19.16, according to ZipRecruiter salary data. Most workers in this role earn between $16.35 and $20.67 per hour, depending on experience, location, and employer.

What are some common challenges faced in a Qnxt Claims Processing role, and how can they be effectively managed?

Professionals in Qnxt Claims Processing often encounter challenges such as navigating complex insurance policies, resolving discrepancies in claim data, and meeting tight deadlines while maintaining a high level of accuracy. Effective management of these challenges involves a strong attention to detail, familiarity with Qnxt software functionalities, and clear communication with both internal teams and external providers. Additionally, staying updated on regulatory changes and participating in ongoing training can help streamline processes and reduce errors, making the work more efficient and less stressful.

What is the difference between Qnxt Claims Processing vs Claims Analyst?

AspectQnxt Claims ProcessingClaims Analyst
CertificationsHealthcare IT, Claims Processing CertificationsClaims Processing, Healthcare Billing Certifications
Work EnvironmentHealthcare insurance companies, third-party administratorsInsurance companies, healthcare providers, third-party payers
Job FocusManaging and processing claims using Qnxt softwareAnalyzing claims data, resolving discrepancies, ensuring accuracy

Qnxt Claims Processing specialists primarily focus on managing claims through the Qnxt platform, ensuring efficient processing and compliance. Claims Analysts, on the other hand, analyze claims data, identify issues, and resolve discrepancies. While both roles require knowledge of healthcare claims and certifications, Qnxt Claims Processing roles are more technical and software-specific, whereas Claims Analysts focus on data analysis and problem-solving within the claims process.

What are the key skills and qualifications needed to thrive as a QNXT Claims Processor, and why are they important?

To thrive as a QNXT Claims Processor, you need strong analytical skills, attention to detail, and a solid understanding of healthcare insurance claims, often supported by relevant experience or training. Proficiency in QNXT claims management software, knowledge of ICD-10, CPT coding, and familiarity with HIPAA regulations are typically required. Excellent communication, organizational abilities, and problem-solving skills help you manage claim inquiries and resolve discrepancies effectively. These skills ensure accurate claims adjudication, timely processing, and compliance with regulatory standards, which are vital for operational efficiency in healthcare organizations.

What is QNXT claims processing?

QNXT claims processing refers to the use of the QNXT software platform, developed by TriZetto, to automate and manage healthcare claims for insurance companies and healthcare providers. This system streamlines the claims lifecycle, from submission and validation to adjudication and payment. It helps organizations improve accuracy, reduce processing times, and ensure compliance with industry regulations. QNXT is widely used in the healthcare industry to increase operational efficiency and enhance member and provider satisfaction.
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Qnxt Claims Processing jobs near you

TEST ENGINEER

APWU AFL-CIO HEALTH PLAN

Elkridge, MD • On-site

Full-time

Posted 16 days ago

Job description

Claims Adjudication System (Tester/Validator)


The APWU Health Plan is seeking a Claims Adjudication System Tester/Validator to join our Testing Department.

This position is responsible for developing and validating test plans, conducting acceptance and regression testing for the heath claims processing system and other interactive systems.

PRIMARY ACCOUNTABILITIES:

  • Primarily focusing on testing and validation for upgrades, add-ons, benefit changes and continued maintenance of the QNXT claims processing system.
  • Testing and validation of all business-related applications.
  • Work with Health Plan Business Analysts (and others as needed) to ensure that test plans and scenarios cover all testable requirements and provides detailed feedback to the Information Technology staff related to application set-up or possible design flaws.
  • Keep detailed testing documentation including screen prints of system set-up and testing results, both positive and negative.
  • Review and/or develops reports as needed to ensure thorough testing as well as to identify trends in system issues;
  • Identify innovative methodologies to guarantee that tests are as fail-safe as possible and that potential fallout from fixes is tested;
  • Documents details of bugs found during testing and notifies affected parties;
  • Schedules status meetings as necessary to include all affected parties;
  • Maintain and/or enhance system skills as needed to sustain a superior knowledge of the Plan’s workflow, policies, procedures and system(s) capabilities.
  • Work hours outside of normal work day/week when necessary;
  • Other duties as assigned.

QUALIFICATIONS:

  • 2-4 years software testing experience or 5+ years of experience in testing methodology and practical application in a healthcare environment.
  • A minimum of 3 years healthcare claims processing, review or support staff experience.
  • Excellent verbal and written communication skills.
  • Excellent problem solving and issue identification skills.
  • Ability to work well independently.
  • Proficiency with Microsoft Suite.
  • SQL knowledge preferred.
  • Experience with the QNXT system is preferred.
  • Experience and proficiency with claims editing software.
  • Experience and proficiency with Claim Test Pro a plus.
  • Experience with automated test tools a plus.
  • A.A. degree and professional industry certification preferred.


Please ensure all of the above requirements are clearly reflected in your resume or specifically addressed in your cover letter. Stated salary requirements (range is acceptable) are required for consideration. No relocation assistance available. Must pass criminal records check prior to employment. Please apply on-line.


EOE M/F/D/V; Drug-Free Employer