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Qnxt Claims Processing Jobs (NOW HIRING)

UHS

Claims Auditor/Trainer

Reno, NV · On-site

$26.65 - $38/hr

... claims processing and compliance required. • QNXT system experience highly preferred. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal ...

CEDENT

QNXT Configuration Architect

$40 - $60/hr

... Claim Processing, Billing, Plan/Product. • Experience with Healthcare domain. • Strong ... claims and how that goes into product and benefit configuration Compensation Hourly Rate Range ...

CommunityCare, Inc.

$85 - $110/hr

... Member, Provider, Claims, Clinical, benefit package, and organizational policy domains, and ... Document legacy core-system business processes and user workflows; map each to its corresponding ...

New

Massgeneralbrigham

Senior EDI Developer

Somerville, MA · On-site

Preferred qualifications include exposure to QNXT (claims and enrollment processing systems), ASP.NET development, and XML/XSLT programming, which support complex EDI transformations and integrations.

TekCommands Inc

BSA - Healthcare Payer

OR · Remote

Collaborate with business SMEs to define claims processing rules, benefit configuration ... Experience with Facets, QNXT, HealthRules, NASCO, or equivalent payer platforms preferred.

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Qnxt Claims Processing information

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How much do qnxt claims processing jobs pay per hour?

As of Sep 4, 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 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.
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Qnxt Claims Processing jobs near you
Infographic showing various Qnxt Claims Processing job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 1% Temporary, 3% Contract, and 1% Nights. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $39,863 per year, or $19.2 per hour.

Quality Control Reviewer II

1199SEIU Funds

Manhattan, NY • On-site

Full-time

Posted 20 days ago

Job description

Responsibilities

        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)

        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

        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

        Process and evaluate facility claims manually or through DMS

        Apply overpayments and refunds received and reported by the Claims Quality Assurance Department

        Resolve complex issues involving: 1st and 2nd level appeals

        Perform additional duties and projects as assigned by management

Qualifications

        High School Diploma or GED required, some College or Degree preferred

        Minimum (2) two years hospital claims processing  experience 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

Employment Type: Full time

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