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Qnxt Configuration Jobs (NOW HIRING)

HJ Staffing

Sr. QNXT Software Engineer

Phoenix, AZ · On-site

$121K - $160K/yr

HJ Staffing is seeking a Sr. QNXT Software Engineer with deep healthcare technology experience to ... Ensure software configuration management and change management best practices are followed. What ...

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HJ Staffing

Sr. QNXT Software Engineer

Phoenix, AZ · On-site

$121K - $160K/yr

HJ Staffing is seeking a Sr. QNXT Software Engineer with deep healthcare technology experience to ... Ensure software configuration management and change management best practices are followed. What ...

Tammina

Health Insurance - QNXT

Scottsdale, AZ

... QNXT, Agile Methodology Experience, Informatics Experience At least 3 Years of expertise in ... configuration management, etc... At least 3 years of experience in Actuarial and Health Insurance ...

Tammina

Health Insurance - QNXT

Scottsdale, AZ · On-site

At least 4 years of QNXT, Agile Methodology Experience, Informatics Experience * At least 3 Years ... At least 2 years of experience in Development/ Configuration/solutions evaluation/ Validation and ...

TecTammina

Health Insurance - QNXT

Scottsdale, AZ

At least 4 years of QNXT, Agile Methodology Experience, Informatics Experience * At least 3 Years ... At least 2 years of experience in Development/ Configuration/solutions evaluation/ Validation and ...

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Qnxt Configuration information

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How much do qnxt configuration jobs pay per year?

As of Jul 7, 2026, the average yearly pay for qnxt configuration in the United States is $95,935.00, according to ZipRecruiter salary data. Most workers in this role earn between $76,000.00 and $112,000.00 per year, depending on experience, location, and employer.

What are typical daily responsibilities for a Qnxt Configuration specialist?

As a Qnxt Configuration specialist, your daily responsibilities often involve analyzing client or organizational requirements, configuring health plan benefits and provider networks within the QNXT system, and troubleshooting configuration issues. You will work closely with business analysts, quality assurance teams, and other IT professionals to implement system changes and support ongoing operations. Additionally, staying updated with regulatory changes and client needs is important to keep configurations accurate and compliant. This role typically involves balancing independent tasks with team collaboration, making strong organization and communication skills valuable assets.

What is a Qnxt Configuration job?

A Qnxt Configuration job involves setting up and maintaining the QNXT healthcare platform to support health plan operations. This includes configuring benefits, provider networks, claims processing rules, and system workflows to ensure compliance with business and regulatory requirements. Professionals in this role collaborate with business analysts, developers, and stakeholders to optimize system performance and troubleshoot configuration issues. Strong analytical skills and knowledge of managed care processes are essential for success in this position.

What are the key skills and qualifications needed to thrive in the Qnxt Configuration position, and why are they important?

To thrive as a Qnxt Configuration professional, you need a solid understanding of healthcare insurance processes, experience in configuring QNXT (a TriZetto healthcare management platform), and proficiency with claims, provider, and benefits modules. Technical skills with relational databases, SQL, and familiarity with regulatory requirements such as HIPAA, along with certifications like CBIP or relevant system training, are highly valued. Strong problem-solving abilities, attention to detail, and effective communication are important soft skills for collaborating across IT and business teams. These combined skills ensure accurate system configuration, regulatory compliance, and efficient support of healthcare operations.

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Qnxt Configuration jobs near you
Infographic showing various Qnxt Configuration job openings in the United States as of July 2026, with employment types broken down into 95% Full Time, 1% Part Time, and 4% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $95,935 per year, or $46.1 per hour.
Analyst, Configuration Oversight-Provider Contracts/Claims/QNXT/Conga

Analyst, Configuration Oversight-Provider Contracts/Claims/QNXT/Conga

Molina Healthcare

Long Beach, CA • On-site, Remote

$49K - $107K/yr

Full-time

Posted 26 days ago

Molina Healthcare rating

8.1

Company rating: 8.1 out of 10

Based on 193 frontline employees who took The Breakroom Quiz

143rd of 277 rated insurance

Job description


JOB DESCRIPTION Job Summary
Responsible for comprehensive contract review and target claim audits review. This includes but not limited to; deep dive contract review and targeted claim audits related to accurate and timely implementation and maintenance of critical information on all claims and provider databases, validate data housed on databases and ensure adherence to business and system requirements of stakeholders as it pertains to provider contracting, network management, credentialing, benefits, prior authorizations, fee schedules, and other business requirements critical to claim accuracy. This contract review provides oversight to ensure that the contracts are configured correctly in QNXT. The claims are reviewed to ensure that the configured services are correct. Maintain the audit workbooks and provide summation regarding the assigned tasks. Manage findings follow-up and tracking with stakeholders/requestors.
Ensure that the assigned tasks are completed in a timely fashion and in accordance with department standards.
Job Duties for this position:
• Analyze and interpret data to determine appropriate configuration.
• Comprehensive understanding of contracts reviews to detect any gaps in the correct payment of claims
Make recommendations for potential revision and updates
• Interprets accurately specific state and/or federal benefits, contracts as well as additional business requirements and converting these terms to configuration parameters.
• Ability to interpret contract term agreements pertaining to Line of Business (LOB) and States for all different claim types and services billed under Institutional and non-institutional claims.
• Validates coding, updating and maintaining benefit plans, provider contracts, fee schedules and various system tables through the user interface to ensure current contract and/or amendment rates align in our system.
• Apply previous experience and knowledge to verify accuracy of updates to claim/encounter and/or system update(s) as necessary.
• Works with fluctuating volumes of work, various audit types and must be able to prioritize work to meet deadlines and Business Needs
• Reviews documentation regarding updates/changes to member enrollment, provider contract, provider demographic information, claim processing guidelines and/or system configuration requirements. Evaluates the accuracy of these updates/changes as applied to the appropriate modules within the core claims processing system (QNXT).
• Clearly documents the audit results and makes recommendations as necessary.
• Helps to evaluate the adjudication of claims using standard principles and state specific policies and regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims.
• Prepares, tracks, and provides audit findings reports according to designated timelines
Presents audit findings and makes recommendations to management for improvements based on audit results.
Job Qualifications
REQUIRED EDUCATION:
Associate's degree or equivalent combination of education and experience
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
  • Comprehensive claims processing experience (QNXT) as Examiner or Adjuster
  • Experience independently reviewing and processing simple to moderately complex High dollar claims and knowledge of all claim types of reimbursements not limited to payment methodologies such Stoploss, DRG, APC, RBRVS, FFS applicable for HD Inpatient, Outpatient and Professional claims.
  • Knowledge of relevant CMS rules and/or State regulations with different line of business as: Medicare, Medicaid, Marketplace, Dual coverages/COB.
  • 2+ years of comprehensive claim audits as preference
  • Knowledge of validating and confirming information related to provider contracting, network management, credentialing, benefits, prior authorizations, fee schedules, and other business requirements
  • Proficient in claims software and audit tools not limited to QNXT, PEGA, NetworX Pricer, Webstrat, Encoder Pro and Claims Viewer.
  • Strong analytical and problem-solving abilities, able to understand, interpret and read out through SOPs, Job Aid guidelines.
  • Knowledge of verifying documentation related to updates/changes within claims processing system .
  • Strong knowledge of using Microsoft applications to include Excel, Word, Outlook, PowerPoint and Teams
  • The candidate must have the ability to prioritize multiple tasks, meet deadlines and provide excellent customer service skills.

PREFERRED EDUCATION:
Bachelor's Degree or equivalent combination of education and experience
PREFERRED EXPERIENCE:
3+ years of experience in claims as Adjuster or claims examiner in the healthcare field
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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About Molina Healthcare

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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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