Lead Analyst, Configuration Information Management (Claims Adjudication/ Networx/ QNXT)

This is a Fully Remote Job
1. About Our Client:
The organization operates in the managed care industry, focusing on programs such as Medicaid, Medicare, and Marketplace offerings. It addresses challenges related to regulatory compliance, claims processing, and reimbursement by developing clear system configuration requirements that support compliant and timely claim payments. The organization works closely with health plans and corporate partners to manage complex healthcare benefit and payment processes.
2. About the Opportunity:
The Lead Analyst, Configuration Information Management (Claims Adjudication/ Networx/ QNXT) is responsible for interpreting regulatory and contractual requirements to define configuration parameters that ensure accurate claims processing and reimbursement. This role supports the organization by translating complex requirements into actionable system configurations, collaborating across multiple teams to maintain compliance, and driving improvements that impact financial performance and operational efficiency.
3. Responsibilities:
Interpret federal, state, contractual, and business requirements into clear system configuration parameters.
Develop and maintain documentation on coverage, reimbursement, and claims processing requirements.
Monitor regulatory and industry updates to assess impacts on products, payments, compliance, and financials.
Coordinate reviews, governance activities, approvals, and implementation timelines with health plans and partners.
Communicate requirement changes to stakeholders ensuring alignment and documentation.
Support defect resolution and issue management related to claims and requirements.
Develop standards and best practices for requirement interpretation and configuration.
Provide reporting and analysis on regulatory changes, compliance, claim trends, appeals, and financial impacts.
Collaborate with Regional Product Managers and other teams to align benefits, coding, and system requirements.
Research industry practices and recommend improvements.
Lead complex cross-functional projects with minimal direction.
Build effective relationships across health plans and corporate functions.
Synthesize complex requirements into concise guidance.
Maintain regulatory information including policy and legislative changes.
Work independently in a remote, multi-time-zone environment.
Manage competing priorities and aggressive timelines while maintaining quality.
Support implementation and conversion activities for health plans and system updates.
Define business objectives, document requirements, and negotiate timelines with partners.
Serve as a subject matter expert in system management and help establish standards and guidelines.
Create reporting tools and communications for configuration updates and projects.
Train and support team members on system functionality and updates.
Manage fluctuating workloads and prioritize assignments.
4. Requirements:
Minimum five years of experience in system management, database maintenance, or analysis within managed care operations for Medicaid, Medicare, or Marketplace programs.
Advanced experience with claims processing systems and documentation validation.
Strong analytical, critical-thinking, problem-solving, and attention to detail.
Ability to adapt to changing business needs and deliver accurate work on time.
Effective written and verbal communication skills.
Proficiency in Microsoft Office, particularly intermediate to advanced Excel skills (VLOOKUPs, PivotTables).
Familiarity with claims processing systems such as QNXT and Networx Pricer.
5. Pay Range and Compensation Package:
The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors.
Equal Opportunity Statement:
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.

Work arrangement
Yes