Job ID: JOB_ID_6390
About the Role:
We are seeking a skilled QNXT Medicaid Tester to play a critical role in ensuring accurate claims adjudication, enrollment processing, and regulatory compliance within complex healthcare payer systems. You will join a team supporting enterprise Medicaid programs powered by the TriZetto QNXT platform, driving high-quality, compliant healthcare solutions.
Key Responsibilities:
- Validate Medicaid-focused claims processing, enrollment, premium billing, and encounter reporting within QNXT.
- Test rules-driven claims adjudication, pricing logic, and benefit configurations.
- Support end-to-end testing cycles, including functional, integration, regression, performance, and data validation.
- Ensure compliance with state and federal Medicaid regulations.
- Collaborate with business analysts, QA teams, and project managers to resolve configuration gaps.
Required Qualifications:
- 3-7 years of experience in QNXT testing within Medicaid environments.
- Strong understanding of Medicaid operations (UM, Prior Authorization, Capitation, PMPM, TPL/COB).
- Hands-on experience with 834, 820, NCPDP file formats, and MMIS submissions.
- Experience with test planning, execution, defect tracking, and validation within QNXT.
Preferred Qualifications:
- Experience with large payer organizations or Medicaid agencies.
- Strong analytical mindset with excellent documentation and stakeholder communication skills.
- Experience supporting QNXT upgrades, releases, and audit readiness documentation.
We value detail-oriented professionals who understand Medicaid compliance, enjoy solving complex claims scenarios, and can ensure accurate QNXT configurations in dynamic healthcare environments.
Compensation & Location
Salary: $70,000 – $120,000 per year (Estimated)
Location: Remote
Recruiter / Company – Contact Information
Email: i@artigencetech.com
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