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Qnxt Claims Processing Jobs in Tennessee (NOW HIRING)

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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?

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.

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 Tennessee?

For Qnxt Claims Processing jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Qnxt Claims Processing jobs in Tennessee look for?

The top searched job categories for Qnxt Claims Processing jobs in Tennessee are:

Qnxt Claims Processing jobs near you
Infographic showing various Qnxt Claims Processing job openings in Tennessee as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, 1% Temporary, 4% Contract, and 1% Nights. Highlights an 91% Physical, 3% Hybrid, and 6% Remote job distribution.

Senior Manager, Medical Economics

Hispanic Alliance for Career Enhancement

Nashville, TN • On-site

$68 - $199/hr

Other

Medical, Dental, Vision, Retirement, PTO

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

We are seeking a Senior Manager, Medical Economics (IC) to provide technical and analytic leadership in support of a newly created team.

We're building something new-and this role is at the center of it.

Senior Manager, Medical Economics

you'll play a critical role in shaping Aetna's newly established Finance Data Governance function. You'll provide hands‑on technical and analytical leadership that helps modernize our finance data ecosystem and unlock high‑impact analytics, reporting, and performance measurement across the organization.

This is a highly visible individual contributor role for a data‑savvy leader who thrives at the intersection of healthcare data, finance, and strategy-and who can translate complex data assets into meaningful business outcomes.

What You'll Own
  • Support the execution of data governance activities as they relate to the Aetna Data Lakehouse assets on Google Cloud Platform. Activities will include domain ownership of Aetna claims data, data quality initiatives and best practices as well as managing the communication strategy out to our Finance colleagues.
  • Assist the Data Governance Lead in aligning finance priorities and investments to Governance activities, communicating on how the Data Governance model aligns with our data strategy and enables the realization of new opportunities.
  • Collaboration with DDAT Data Governance teams to align Enterprise goals and tooling with Aetna Lakehouse data assets.
  • Collaborate with Data Stewards to support Data Portal.
  • Offer expert knowledge and insight into Aetna data and its applications to DDAT partners and other members of the Governance team.
  • Collaborate and create strategic partnerships with business stakeholders from across Health Care Business.
Required Qualifications
  • 5-8 years of finance experience, in strategic, analytical, or operationally‑focused roles.
  • Expert in the data domains we are building, or self motivated to learn quickly.
  • Demonstrates critical thinking and expresses ideas clearly, concisely, and logically from a cross functional perspective.
  • Demonstrated ability to build relationships quickly.
Preferred Qualifications
  • Knowledge of claims data within source data from ACAS, HRP and QNXT adjudication platforms.
  • Data governance and date enablement
  • Standing up systems/moving data into GCP
  • Experience with data quality, creating and managing materiality metrics.
  • Knowledge of Financial system
  • Advanced skills in SQL and Web-based query tools and reporting, forecasting, financial modeling, and trend analysis.
Education

Bachelors Degree

Pay Range

The typical pay range for this role is:

$67,900.00 - $199,144.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/31/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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