Remote-Medical Claims Configuration Lead (NetworX SME)

NOTE: This is a 100% remote position. Selected candidates will be working on EST hours.

Job Title: Medical Claims Pricing Configuration Lead (NetworX SME)

Location: Fully Remote (Applicants must reside in one of the following states: AL, DE, FL, GA, ID, IN, KS, LA, ME, MD, MN, NE, NV, NH, NC, ND, OH, OK, PA, SC, SD, TN, TX, UT, VA, WA, WV, WI, WY)

This is an excellent opportunity for a pricing configuration leader who thrives on solving complex problems, enjoys working remotely, and brings deep subject matter expertise in healthcare reimbursement systems.

Overview:

Seeking a seasoned NetworX Configuration Subject Matter Expert to step into a leadership role overseeing the setup and optimization of pricing systems for medical claims. This fully remote opportunity requires a deep understanding of pricing configuration platforms-especially NetworX Pricer and Optum tools-as well as the operational know-how to streamline provider contract execution and claim accuracy.

What You'll Do:

• Lead Configuration Strategy: Direct a team of configuration analysts, providing coaching, performance feedback, and strategic leadership to optimize system functionality.
• Drive Pricing Improvements: Act as a key contributor in accelerating end-to-end enhancements in provider contract pricing. Collaborate across workgroups to elevate execution speed and process quality.
• Optimize Systems: Manage and maintain pricing tools such as QNXT, NetworX Pricer, and Optum Rate Manager to ensure claims are adjudicated accurately and efficiently.
• Manage Provider Contracts: Collaborate with project or configuration managers to configure and monitor provider contracts and fee schedules while ensuring they align with compliance requirements.
• Enhance Operational Processes: Identify inefficiencies in unit-level operations and implement refinements to improve turnaround time and data accuracy.
• Troubleshoot and Resolve: Proactively identify and fix system-level issues that affect claims processing and reimbursement accuracy.
• Ensure Regulatory Compliance: Uphold policies, regulatory requirements, and standard procedures across all configuration activities.

What We're Looking For:

• Experience: Minimum 8 years in healthcare systems/configuration, with hands-on experience in claim pricing and configuration workflows.
• Expertise in Pricing Platforms: Strong command of NetworX Pricer, Optum Pricers, and ideally QNXT.
• Healthcare Acumen: Solid foundation in medical claims processing, provider reimbursement strategies, and pricing methodologies.
• Leadership Skills: Proven ability to lead teams, manage performance, and drive results in high-stakes environments.
• Communication: Excellent verbal and written communication skills to effectively liaise with cross-functional stakeholders.
• Analytical Thinking: Strong problem-solving skills with the ability to evaluate complex issues and design actionable solutions.
• Compliance Knowledge: Deep familiarity with industry regulations and best practices for claims pricing and configuration.

Preferred Qualifications:

• Proficiency in QNXT or similar claims administration platforms
• Background in overseeing pricing elements during system migrations
• Experience managing quality improvement initiatives in claims operations

Interested candidates may submit their resumes online or call at 310-906-4780 for further information regarding the position.

Beacon Hill is an equal opportunity employer and individuals with disabilities and/or protected veterans are encouraged to apply.

California residents: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

If you would like to complete our voluntary self-identification form, please click here or copy and paste the following link into an open window in your browser: https://jobs.beaconhillstaffing.com/eeoc/

Completion of this form is voluntary and will not affect your opportunity for employment, or the terms or conditions of your employment. This form will be used for reporting purposes only and will be kept separate from all other records.

Company Profile:

Beacon Hill Technologies, a premier National Information Technology Staffing Group, provides world class technology talent across all industries utilizing a complete suite of staffing services. Beacon Hill Technologies' dedicated team of recruiting and staffing experts consistently delivers quality IT professionals to solve our customers' technical and business needs.

Beacon Hill Technologies covers a broad spectrum of IT positions, including Project Management and Business Analysis, Programming/Development, Database, Infrastructure, Quality Assurance, Production/Support and ERP roles.

Learn more about Beacon Hill and our specialty divisions, Beacon Hill Associates, Beacon Hill Financial, Beacon Hill HR, Beacon Hill Legal, Beacon Hill Life Sciences and Beacon Hill Technologies by visiting www.bhsg.com.

Benefits Information:

Beacon Hill offers a robust benefit package including, but not limited to, medical, dental, vision, and federal and state leave programs as required by applicable agency regulations to those that meet eligibility. Upon successfully being hired, details will be provided related to our benefit offerings.

We look forward to working with you.

Beacon Hill. Employing the Future™