Assess and redesign end-to-end processes across claims, enrollment, billing, customer service ... Facets, QNXT, HealthRules, or custom-developed core administration systems * Experience with ...
New
Assess and redesign end-to-end processes across claims, enrollment, billing, customer service ... Facets, QNXT, HealthRules, or custom-developed core administration systems * Experience with ...
New
Payer Back Office Strategy / Technology / Operations Consultant, Manager
Indianapolis, IN · On-site
$99K - $232K/yr
... processes, improve productivity, and drive business performance. As an operations consulting ... in claims, enrollment, billing, and membership - Familiarity with technology solutions enabling ...
Payer Back Office Strategy / Technology / Operations Consultant, Manager
Indianapolis, IN · On-site
$99K - $232K/yr
... processes, improve productivity, and drive business performance. As an operations consulting ... in claims, enrollment, billing, and membership - Familiarity with technology solutions enabling ...
Qnxt Claims Processing information
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.
What are the key skills and qualifications needed to thrive as a QNXT claims processor?
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 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?
| Aspect | Qnxt Claims Processing | Claims Analyst |
|---|---|---|
| Certifications | Healthcare IT, Claims Processing Certifications | Claims Processing, Healthcare Billing Certifications |
| Work Environment | Healthcare insurance companies, third-party administrators | Insurance companies, healthcare providers, third-party payers |
| Job Focus | Managing and processing claims using Qnxt software | Analyzing 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.
Is Qnxt Claims Processing a stressful job?
Qnxt Claims Processing roles can be stressful due to the high volume of claims and strict deadlines. The job requires attention to detail, accuracy, and familiarity with claims management software, which can contribute to work pressure, especially during busy periods.
What are popular job titles related to Qnxt Claims Processing jobs in Indiana?
For Qnxt Claims Processing jobs in Indiana, the most frequently searched job titles are:
- Medical Claims Supervisor
- Evening Cvs Health Claims Benefits Specialist
- Claims Adjudicator
- Contract Healthcare Claims Analyst
- Remote Claims Recovery Specialist
- Trainee Medical Claims Processor
- Insurance Claims Specialist
- Remote Medical Claims Analyst
- Remote Denial Specialist
- Remote Applications Specialist Ultrasound
What job categories do people searching Qnxt Claims Processing jobs in Indiana look for?
The top searched job categories for Qnxt Claims Processing jobs in Indiana are:
Full-time
Medical
Posted yesterday
New
Deloitte rating
8.2
Based on 93 frontline employees who took The Breakroom Quiz
46th of 152 rated financial services
Job description
Join our AI & Engineering team in transforming technology platforms, driving innovation, and helping make a significant impact on our clients' success. You'll work alongside talented professionals reimagining and re-engineering operations and processes that are critical to businesses. Your contributions can help clients improve financial performance, accelerate new digital ventures, and fuel growth through innovation.
AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements.
AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements.
AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements.
Recruiting for this role ends on 09/30/2026.
Work you'll do
As a Senior Manager on the Industry Solutions team, you will be responsible for helping health plan clients transform core administration, operations, and service delivery capabilities.
- Lead workstreams or full engagements focused on health plan operations transformation, including core administration, pharmacy operations, and operating model redesign
- Assess and redesign end-to-end processes across claims, enrollment, billing, customer service, utilization management, care management, and pharmacy or pharmacy benefit manager operations
- Translate business needs into transformation roadmaps, service delivery models, process improvements, and implementation plans aligned to client priorities
- Manage day-to-day delivery, team performance, quality of work product, and client stakeholder communication across complex transformation programs
- Support business development, proposal development, thought leadership, and go-to-market initiatives, while mentoring junior practitioners across project delivery and client service
A successful candidate would possess these skills:
- Ability to work independently and collaborate as part of a team
- Effective written and verbal communication skills
- Meticulous attention to detail and quality of work product
- Ability to build and sustain professional relationships
- Ability to lead projects or workstreams
- Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
- Strong interpersonal skills and professional demeanor
- Ability to meet deadlines
- Ability to mentor and provide clear guidance to others
The team
Deloitte's Industry Solutions team helps organizations address business, operational, and technology challenges through transformation programs tailored to industry needs. Within Healthcare Industry Solutions, practitioners work with health plan clients on core administration, operations, pharmacy, and service delivery transformation efforts designed to improve efficiency, compliance, and member experience.
Qualifications
Required:
- Bachelor's degree and 8+ years of experience in health care, health plan operations, or consulting
- 7+ years of experience implementing or configuring core administration platforms such as Facets, QNXT, HealthRules, or custom-developed core administration systems
- Experience with configuration or functional design across claims adjudication, enrollment, billing, and benefits setup
- Experience leading process redesign, operating model transformation, or large-scale business transformation initiatives for health plan organizations, including management of project delivery, workstreams, or cross-functional teams
- Experience developing client deliverables using Microsoft Excel and Microsoft PowerPoint
- Ability to travel 50%, on average, based on the work you do and the clients and industries/sectors you serve.
- Limited immigration sponsorship may be available.
Preferred:
- Master's degree in Business Administration, Master of Health Administration, or similar field
- Experience supporting health plan clients across claims, enrollment, billing, service operations, care management, or utilization management
- Experience with health plan technology such as application programming interface-enabled core administration, cloud migration, legacy-to-software as a service transitions, HealthEdge, FACETS, Tapestry, or custom solutions
- Experience delivering health plan implementations, including product launches, Affordable Care Act, Medicare, or Medicaid compliance builds, or platform migrations
- Experience contributing to business development, proposal development, or thought leadership
- Experience working with senior client stakeholders
The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $189,200 to $372,900.
You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.
Qualifications:Join our AI & Engineering team in transforming technology platforms, driving innovation, and helping make a significant impact on our clients' success. You'll work alongside talented professionals reimagining and re-engineering operations and processes that are critical to businesses. Your contributions can help clients improve financial performance, accelerate new digital ventures, and fuel growth through innovation.AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements.
Recruiting for this role ends on 09/30/2026.
Work you'll do
As a Senior Manager on the Industry Solutions team, you will be responsible for helping health plan clients transform core administration, operations, and service delivery capabilities.
- Lead workstreams or full engagements focused on health plan operations transformation, including core administration, pharmacy operations, and operating model redesign
- Assess and redesign end-to-end processes across claims, enrollment, billing, customer service, utilization management, care management, and pharmacy or pharmacy benefit manager operations
- Translate business needs into transformation roadmaps, service delivery models, process improvements, and implementation plans aligned to client priorities
- Manage day-to-day delivery, team performance, quality of work product, and client stakeholder communication across complex transformation programs
- Support business development, proposal development, thought leadership, and go-to-market initiatives, while mentoring junior practitioners across project delivery and client service
A successful candidate would possess these skills:
- Ability to work independently and collaborate as part of a team
- Effective written and verbal communication skills
- Meticulous attention to detail and quality of work product
- Ability to build and sustain professional relationships
- Ability to lead projects or workstreams
- Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
- Strong interpersonal skills and professional demeanor
- Ability to meet deadlines
- Ability to mentor and provide clear guidance to others
The team
Deloitte's Industry Solutions team helps organizations address business, operational, and technology challenges through transformation programs tailored to industry needs. Within Healthcare Industry Solutions, practitioners work with health plan clients on core administration, operations, pharmacy, and service delivery transformation efforts designed to improve efficiency, compliance, and member experience.
Qualifications
Required:
- Bachelor's degree and 8+ years of experience in health care, health plan operations, or consulting
- 7+ years of experience implementing or configuring core administration platforms such as Facets, QNXT, HealthRules, or custom-developed core administration systems
- Experience with configuration or functional design across claims adjudication, enrollment, billing, and benefits setup
- Experience leading process redesign, operating model transformation, or large-scale business transformation initiatives for health plan organizations, including management of project delivery, workstreams, or cross-functional teams
- Experience developing client deliverables using Microsoft Excel and Microsoft PowerPoint
- Ability to travel 50%, on average, based on the work you do and the clients and industries/sectors you serve.
- Limited immigration sponsorship may be available.
Preferred:
- Master's degree in Business Administration, Master of Health Administration, or similar field
- Experience supporting health plan clients across claims, enrollment, billing, service operations, care management, or utilization management
- Experience with health plan technology such as application programming interface-enabled core administration, cloud migration, legacy-to-software as a service transitions, HealthEdge, FACETS, Tapestry, or custom solutions
- Experience delivering health plan implementations, including product launches, Affordable Care Act, Medicare, or Medicaid compliance builds, or platform migrations
- Experience contributing to business development, proposal development, or thought leadership
- Experience working with senior client stakeholders
The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $189,200 to $372,900.
You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.
Education:Bachelor's DegreeEmployment Type:
About Deloitte
Sourced by ZipRecruiter
Industry
Finance and insurance and business management consulting
Company size
10,000+ Employees
Headquarters location
Orlando, FL, US