QNXT Accumulators SME in Washington, District of Columbia at Educology Solutions

We are seeking a highly specialized QNXT Accumulators Subject Matter Expert (SME) to join our team in a critical leadership and technical role. The ideal candidate is not only a hands-on technical expert with TriZetto/Cognizant QNXT but also an assertive leader capable of facilitating cross-functional meetings and driving technical teams to execute deliverables.

In this role, you will act as the bridge between technical configuration, claims processing, and enrollment. You will be relied upon to dig deep into the QNXT backend, write and interpret complex SQL queries, and perform end-to-end root cause analysis on accumulator issues. If you are a proactive problem-solver who thrives on leading troubleshooting efforts and ensuring accurate claims adjudication, we want you on our team.

RESPONSIBILITIES

Project & Team Leadership: Act as the primary driver for accumulator-related initiatives. Lead cross-functional meetings, set clear action items, hold technical and business teams accountable, and push projects through to completion.
Accumulator Management: Serve as the ultimate Subject Matter Expert (SME) for all things related to accumulators, taking ownership of their configuration, routine maintenance, and complex troubleshooting.
QNXT Backend Navigation: Utilize your deep working knowledge of the QNXT platform to navigate backend tables. Write, execute, and interpret SQL queries to extract data, validate configurations, and resolve systemic issues.
Claims Adjudication Alignment: Apply a deep understanding of core claims processing workflows to determine exactly how accumulator balances (e.g., out-of-pocket maximums, deductibles) are impacting claim adjudication and payment integrity.
Enrollment Data Synchronization: Oversee how accumulator updates are managed within enrollment data. Analyze enrollment tables to resolve discrepancies caused by retro-enrollment, plan changes, or demographic updates.
End-to-End Root Cause Analysis: Triage complex, multi-system defects. Trace data flows from 834 enrollment files through to the accumulator tables and 837/835 claims outputs to identify and resolve root causes.

QUALIFICATIONS
Experience: Minimum of five (5) years of experience acting as a Subject Matter Expert in healthcare accumulators (configuration, maintenance, and troubleshooting).
QNXT Mastery: Minimum of five (5) years of hands-on experience with the QNXT system, specifically with backend navigation and the ability to write and interpret database queries (SQL/T-SQL).
Leadership Skills: Proven ability to lead technical meetings, confidently articulate issues to both IT and business stakeholders, and drive teams toward actionable resolutions.
Domain Knowledge (Claims & Enrollment):
Deep understanding of healthcare claims processing and the direct impact of accumulators on adjudication logic.
Strong practical experience with enrollment data structures, tables, and the downstream effects of enrollment updates on accumulator accuracy.
Analytical Skills: Exceptional investigative skills with a track record of performing end-to-end root cause analysis across highly integrated healthcare IT systems.