Benefit Optimization Specialist

Quartz is seeking to add a charismatic and engaging Benefit Optimization Specialist join our Care Management team. This position will play a key role in identifying, engaging, and supporting members who may benefit from alternative or supplemental payer programs, including Medicare, Medicaid, and other state or federal coverage options. This position ensures members receive the education, guidance, and care coordination they need to navigate payer transitions, while maintaining compliance with all regulatory requirements. The Specialist collaborates across clinical, operational, and data teams to support seamless transitions and optimize payer alignment.

Benefits:

• Full-time virtual, telecommuting, work from home option available.
• Opportunity to educate and interact with members daily.
• Ideal starting salary, based on skills and experience: $60,100 – 75,200 + robust total rewards package.

• Proactively engage members identified as potentially eligible for alternative payer programs through phone, email, and other communication channels.
• Provide clear, compliant education about eligibility, benefits, enrollment processes, and potential clinical advantages, following CMS, DHS, State of WI, and other regulatory guidelines.
• Address member questions and concerns to support informed decision-making.
• Assist members with application and enrollment processes as allowed under regulatory requirements.
• Monitor ongoing care for transitioned members to ensure needs are met and follow-up care is provided.
• Support accurate and timely claims processing under the new payer.
• Conduct eligibility assessments based on clinical and regulatory requirements.
• Utilize data sources such as claims, clinical records, and member information to identify opportunities for improved payer alignment.
• Partner with clinical, operations, and data teams to streamline member identification, outreach, and enrollment workflows.
• Coordinate with program representatives (e.g., Quartz) to support member transitions and resolve issues.
• Track and document all member engagement activities to ensure accuracy and compliance.
• Analyze engagement data to evaluate outreach effectiveness and recommend process improvements.

• Bachelor’s or Associate’s degree in related field
• 2 + years in care management, payer operations, or patient advocacy
• Experience with Medicaid, Medicare, and dual-eligible (Medicare-Medicaid) populations.
• Experience working with Epic Tapestry, Compass Rose, or other electronic medical record systems.
• Familiarity with Medicare eligibility, ESRD programs, and payer coverage models.
• Knowledge of NCQA standards, CMS guidelines, and Wisconsin DHS regulations.
• Strong understanding of regulatory requirements governing payer transitions.
• Understanding of social determinants of health (SDOH) and their impact on member outcomes.
• Knowledge of local, state, and federal community resources to support member needs.
• Excellent communication, interpersonal, and cultural competence skills.
• Proficiency in Microsoft 365, including Excel, Word, and PowerPoint.

We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. Quartz is a federal contractor and supports a safe, drug-free workplace. All employment offers are contingent upon successful completion of a pre-employment criminal background check.

Quartz values and embraces diversity and is proud to be an Equal Employment Opportunity. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity or expression, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.