100% Remote QNXT Accumulator SME

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This is a 100% Remote position. EST working hours. QNXT Accumulator SME (Claims / Enrollment / Configuration) Overview Seeking a highly analytical QNXT Accumulator Subject Matter Expert (SME) to support complex accumulator configuration, maintenance, troubleshooting, and claims analysis within a healthcare payer environment. This role requires deep expertise in how accumulators interact with claims adjudication, enrollment data, and benefit structures, along with the ability to investigate and resolve end-to-end processing issues across multiple systems and data layers. Must Haves 5+ years of hands-on experience as a Subject Matter Expert (SME) supporting QNXT accumulators Strong expertise in accumulator configuration, maintenance, troubleshooting, and issue resolution Deep working knowledge of QNXT backend functionality, including writing and interpreting SQL queries Strong understanding of healthcare claims processing and adjudication workflows Experience supporting enrollment data, membership tables, and accumulator-related updates within enrollment systems Ability to perform end-to-end analysis across claims, accumulators, and enrollment data to identify root causes and downstream impacts Strong analytical, troubleshooting, and problem-solving skills Ability to work independently in complex, fast-paced production environments Nice to Have Experience with benefit configuration and eligibility processing Exposure to Facets or other healthcare payer platforms Experience supporting production incidents, defect analysis, and operational support teams Knowledge of healthcare payer operations, deductibles, out-of-pocket maximums, and benefit accumulation logic Experience working with reporting, audit validation, or data reconciliation processes Responsibilities Serve as the Subject Matter Expert for QNXT accumulators, including configuration, maintenance, troubleshooting, and operational support Analyze accumulator-related claim issues and determine impacts across claims processing and enrollment data Investigate complex production issues involving claim adjudication, accumulator balances, and member eligibility Write and interpret SQL queries to analyze backend data, validate accumulator behavior, and troubleshoot discrepancies Support enrollment-related accumulator updates and ensure data integrity across membership tables Perform root cause analysis and coordinate resolution efforts across business and technical teams Validate accumulator functionality during system updates, configuration changes, and defect remediation efforts Partner with claims, enrollment, configuration, and IT teams to improve operational accuracy and processing efficiency Document findings, issue resolution steps, and operational procedures to support audit readiness and knowledge sharing Preferred Background Healthcare payer environment Claims operations or claims systems support QNXT configuration or production support teams Enrollment and benefits administration environments Interested candidates may submit their resume online or call at 310-906-4780 for further information regarding the position.

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