QNXT Testing Analyst

Detailed Description From Employer:

Position Title

HRP Analyst / QNXT Benefit Configuration & Claims Testing Analyst

Job Summary

We are seeking an experienced HRP Analyst with strong expertise in QNXT Benefit Configuration and Claims Testing. The ideal candidate should have deep knowledge of benefit setup, claims processing, defect analysis, and testing within the QNXT environment. The resource should be comfortable working across various modules, understanding end-to-end data flows, and validating CXT rules to ensure accurate claims adjudication and benefit processing.

Key Responsibilities

• Work as an HRP Analyst supporting healthcare payer operations and QNXT-related activities.
• Perform benefit configuration, validation, and maintenance activities in QNXT.
• Analyze and understand benefit setup, member eligibility, provider setup, contracts, and plan configuration.
• Conduct end-to-end claims testing in QNXT for professional, institutional, dental, vision, and pharmacy claims.
• Validate claims adjudication results and ensure claims are processed accurately based on configured business rules and benefits.
• Research, troubleshoot, and analyze defects related to claims processing, benefit configuration, and system workflows.
• Review and understand data flows across multiple QNXT modules and integrated systems.
• Navigate and work across all major QNXT screens and modules, including member, provider, benefits, authorizations, pricing, and claims.
• Create and execute detailed test cases, test scenarios, and regression test plans.
• Validate system enhancements, production fixes, and configuration changes.
• Perform backend validation using SQL queries where required.
• Collaborate with business users, developers, configuration teams, QA teams, and operations teams to resolve issues and support project delivery.
• Participate in requirement analysis, impact assessment, and root cause analysis activities.
• Perform detailed validation and testing of CXT rules to ensure proper business logic and claims processing.
• Ensure compliance with healthcare payer standards, policies, and regulatory requirements.

Required Skills

• Strong experience as an HRP Analyst in healthcare payer environments.
• Extensive hands-on experience in QNXT Benefit Configuration.
• Strong expertise in QNXT Claims Testing and Claims Adjudication.
• Deep understanding of benefit setup, claims workflows, pricing, provider configuration, and member enrollment in QNXT.
• Strong knowledge of QNXT screens, navigation, modules, and end-to-end data flows.
• Experience in identifying, analyzing, and resolving defects.
• Strong experience with CXT rules testing and validation.
• Ability to understand business requirements and translate them into test scenarios.
• Knowledge of healthcare payer systems, managed care concepts, and claims life cycle.
• Experience with SQL for backend data validation.
• Familiarity with testing and defect management tools such as JIRA, HP ALM, Quality Center, or Azure DevOps.
• Strong communication, analytical, and documentation skills.

Preferred Qualifications

• Bachelor s degree in Information Technology, Healthcare Administration, Business, or related field.
• Experience working with EDI transactions such as 834, 837, and 835.
• Knowledge of Agile and Scrum methodologies.
• Exposure to Facets, Cognizant CXT, or other healthcare claims platforms is preferred.
• Experience supporting Medicare, Medicaid, or Commercial healthcare plans is an advantage.

Experience Required

• 5+ years of experience in healthcare payer systems and HRP functions.
• 5+ years of experience in QNXT Benefit Configuration and Claims Testing.
• Minimum 2+ years of hands-on experience with CXT rules testing and validation.