Job Listings

- Process enrollment transactions, including entering new member benefit selections and disenrolling members from the system, and processing member benefit changes or eligibility requirements - Process, review and compare electronic and roster files, investigate and update other insurance, and process other enrollment-related reports - Work closely with members, group contacts, agents and regulatory agencies to answer enrollment-related and eligibility inquiries and ensure all enrollment regulations and requirements are met - Identify and resolve issues, including reconciling any eligibility discrepancies - Understand and remain knowledgeable of all enrollment regulations, including but not limited to: effective dates, termination dates and other eligibility-related regulations and requirements

- Process all invoices submitted to Oracle accounts payable system daily – verify general ledger coding, approver routing, and assess for use tax - Supplier profile set-up and maintenance – collection of W9 and ACH forms, ensure all routine supplier payments are paid monthly, and existing supplier profiles are maintained in Oracle - Batch invoices and pay suppliers by check, ACH, and outsourcing options, meeting payment deadlines timely & consistently - Review monthly credit card transaction logs for each corporate cardholder, validate and reconcile receipts to statements, ensure cored documentation and coding of expenses to general ledger accounts - Support compliant monthly and annual filings and financial close, including: monthly Sales & Use Tax returns, monthly Medicaid-related reporting, and annual reconciliation & filing of 1099 NEC and MISC, prepare GAAP journal entries and perform account reconciliations as assigned

- Maintenance and support of Data Management, Reporting, and Analytics Platforms. Responsible for: - Software deployment, configuration, and upgrades. - Stability, performance monitoring, remediation, and improvements. - Serves as the primary liaison with the managed services providers, infrastructure, application development and security teams. - Capacity, growth, and resource planning. - Disaster recovery, planning, and testing. - Support for Development Teams: - Consults and provides support to Business Intelligence and ETL Developers, and Data Analysts. - Enhances team documentation to aid in training and improving off-hour support.

- Strategy Development - Formulate IAM strategies aligned with organizational goals. - Evaluate and select IAM technologies to meet business requirements. - Work with all parties to include project sponsors, vendors, and IT operations groups. - Interface with management and user community to understand business needs, implement security best practices, and identify opportunities for improving security and compliance. - Access Control - Design and implement access control policies and procedures. - Ensure processes for access provisioning and access re-certifications are consistent and repeatable. - Enforce policies and procedures to ensure only authorized personnel have access to information in compliance with Cybersecurity standards. - Oversee user provisioning and de-provisioning process. - Compliance - Drive annual compliance certification and oversee all related controls and documentation management as required. - Ensure IAM practices comply with industry regulations and standards. - Lead efforts to pass audits related to access controls. - Provide oversight, guidance, and development of requirements for vendor selection for new and replacement technologies within the Information Security footprint. - Continuous Improvement - Monitor IAM performance metrics and identify areas for improvement. - Implement continuous improvement initiatives to enhance IAM capabilities. - Team Leadership - Supervise a team of IAM professionals. - Provide mentorship, training, and guidance to team members.

- Collaborate with business stakeholders, external vendors and/or government entities to resolve reported and operational incidents and test technical changes. - Promptly monitor, assign, and work through incidents and requests, based on priority and ensure that service level targets are met. - Perform root cause analysis and contribute to remediation planning and implementation. - Communicate cause, status, and solution to appropriate internal and external stakeholders. - Document service tickets and ensure that technical documentation is consistent with the technical implementation at the point of production deployment and incident resolution. - Write and execute an appropriate test plan for the level of complexity of the solution and work with Quartz Data Warehouse team members to remediate operational and report incident. - Moderate to complex impact analysis and troubleshooting. - Complete impact assessments and ad hoc analyses to ensure that production issues and other reported deficiencies are understood and resolved by updating requirements. - Understand source and target data structures, using standard data tools to review required data and fully profile the data to analyze the impact on downstream data processes, external data submissions, and Quartz business. - Review requirements, technical specifications, and data models and update appropriately based upon final remediation. - Perform data validation and testing for technical changes and process improvements. - Map source system data to data warehouse models. - Work closely with Quartz Data Warehouse team members to fully resolve operational and reported issues. - Test final resolutions and ensure that the implementation meets business requirements and service level targets.

Perform designated executive support duties requiring judgment, initiative, and knowledge of office functions for the designated executive(s)/ director(s). Responsible for providing excellent quality service and maintaining excellent working relationships for internal and external customers. This may include such duties as: - Schedule internal and external meetings/events and appointments via Outlook for leaders as requested (includes scheduling, room reservations, equipment set up and catering orders). Proactive maintenance of calendars. - Prepare, compose, and type letters/memos/emails, graphs, charts, studies, presentations, miscellaneous reports, and research for assigned leader. - Prepare and distribute meeting agendas and materials and attend meetings and take minutes as assigned. Transcribe minutes with appropriate follow-up on action items. - Screen and direct telephone calls, mail, and email to the appropriate person within the organization. Obtain appropriate signatures as needed and requested on documents/contracts/agreements. - Make purchase orders as needed, reconcile company credit card, allocate purchases to appropriate budget cost centers, create expense reports and help others troubleshoot fiscal processes.

- Consult with leadership to understand business requirements and data needs; recommend solutions that address unexpressed and/or underlying needs - Serve as a subject matter expert in advanced data techniques including modeling, integration, visualization, mining, discovery, AI/ML, natural language processing, and solution design - Assemble data sets from disparate sources and analyze using appropriate quantitative methodologies, computations frameworks, and systems - Develop algorithms, predictive models, and create prototype systems, visualizations, and simulations that test and support key business decisions - Develop and deliver automated data products that offer actionable insights and accurate predictions - Optimize models to improve sensitivity and/or specificity for data observations and offer corrective action recommendations to improve the efficacy and/or efficiency of reports, processes, and/or controls - Present data-related findings at internal meetings with non-technical audiences and/or leadership teams to effectively influence strategy - Document and share processes and analyses consistent with organizational best practices, and ensuring compliance with security and internal controls

- Serve as the primary point of contact for reporting, analytics, and insights across Quartz and provider sponsors - Collaborate with executive colleagues and other stakeholders on data-driven initiatives and analyses - Oversee prioritization of key data-related initiatives for Quartz, provider sponsors, and any other stakeholders, including identifying opportunities, considerations, and actions for the bi-directional exchange of data between organizations that drive improvement, cost savings, and efficiencies - Empower and build a high-performing team of data professionals who understand Quartz’s culture, objectives, and strategies to apply effective data analyses and expertise to address organizational concerns, challenges, risks, and opportunities. - Assess the organization’s current capabilities and develop a strategic plan to address any gaps or challenges. - Prioritize data quality, data reporting, data requests, and data needs to ensure accurate and useful business outcomes and actionable insights for Quartz, provider sponsors, and other stakeholders - Design, develop, and maintain functional data repositories for operational and production data from the data warehouse and other vendor data sources - Promote effective teamwork and actively eliminate impediments to collaboration between departments and between Quartz and its provider sponsors - Enhance Quartz’s enterprise-wide data and reporting capabilities - Optimize technology in the data space to create a competitive advantage within the healthcare and health insurance industries - Promote data literacy and a companywide data-driven culture - Establish policies and practices that improve user access to data while ensuring data quality, credibility, protection, and privacy through effective data governance

- Develop and implement strategic formularies and pharmacy programs to improve medication adherence, reduce costs, and enhance patient satisfaction. - Collaborate cross-functionally internally and with external partners to identify, develop, prioritize, and implement outcome-based pharmacy activities: - Quartz Pharmaceutical Care Management (PCM) Program - Quartz Medical Drug Pharmacy Programs. - Quartz Pharmacy Programs. - Clinical Client Consultancy, Sales Support and Client On-boarding. - Trend Management and Reporting. - Provides leadership, support and guidance to Team, Pharmacy Department, Clinical Services and Quartz Health Plan. - Develop and manage SOPs to govern the Pharmacy Programs and Strategy area. - Serve as subject matter experts and provide expertise and assistance to Quartz departments including Customer Service, Sales, Underwriting, Provider Relations, Marketing, Finance, Medical Management, Behavioral Health and Operations. - Ensure compliance of pharmacy benefit management activities with appropriate regulatory (OCI, DOI, CMS, DHS) and accreditation (NCQA) organizations in collaboration with internal areas including assessment of new government program requirements and determine appropriate compliance strategies and implement.

- Process and finalize all requests within turnaround time (TAT) utilizing guidelines and other applicable regulatory requirements - Enter coverage requests into the system and prioritize as required - Check formulary alternatives, review tried and failed medications - Utilize drug references and verify the drug being requested is indicated and approved for the condition - Document all related information regarding the coverage decision - Respond to coverage requests by faxing status to the physician - Conforms to defined roles & responsibilities and rules of engagement between coverage decisions processing and clinical decision making - Partners with assigned clinical pharmacists to accurately and efficiently complete coverage decisions - Accountable to achieve productivity and accuracy standards - Analyzes, researches, and resolves coverage decision processing issues including making written or telephone inquiries to obtain information from PBM, members, physicians, or pharmacies.

- Perform comprehensive market analysis across a variety of geographic markets to include competitive analysis, customer segmentation, SWOT analysis, demographic/behavioral insights, etc. - Interpret data to provide meaningful reports aligned with strategy objectives that will enable smart growth. - Support qualitative and quantitative market research projects by analyzing, interpreting, and reporting key finding to cross functional stakeholders. - Support Voice of the Customer program by analyzing and interpreting both experience and operational data to develop meaningful reports that lead to actionable positive outcomes for the customer. - Review sales, marketing, and product concepts to define help define pain points and strategic objectives. Develop knowledge of multiple business areas, including understanding the business terminology, processes, and organization structure to provide more informed deliverables.

- Identify business requirements and implement policies and procedures to ensure continued compliance with state and/or federal requirements of the Individual ACA and Small Group ACA product lines. - Provide product subject matter expert support to QHP template owners and drive key filing deliverables for timely completion. Collaborate with audit for review and preparation of the QHP Application materials prior to submission to CMS or appropriate state regulators. Responsible for the annual QHP Application submission and Small Group ACA binder filings in accordance with the deadlines set in the final Letter to Issuers and state bulletins. - Develop, maintain, and manage Individual and Small Group ACA product documents to support the annual Open Enrollment Period, including but is not limited to Quartz public web-pages, enrollment materials and member letters, internal reference documents and data tables, and marketing materials. - Analyze Key Performance Indicators and make recommendations that drive product performance. - Complete monthly and quarterly enrollment reporting to state and federal regulators and perform analysis on incoming files from CMS and coordinate operations efforts to implement any enrollment changes/updates required.

- Architects, designs, enhances, and supports delivery of data integrations, enterprise data warehouse, data marts, and data submissions. - Identifies, develops, and documents data acquisition and delivery requirements to meet business and customer needs. - Facilitates group discussions and join data design sessions with the business area subject matter experts. - Designs data models and data processing flows for data acquisition, reporting and analysis. - Develops, implements, and maintains standards and procedures concerning the design and use of data for compilation and delivery. - Coordinates data solution delivery and supports data analysis and data development staff as necessary in the development and maintenance of data implementations. - Queries, analyzes, and interprets complex data stored in the source and target systems. - Play a role in supporting the company’s data governance program to provide definitions, visibility, and access controls for corporate data. - Works with business stakeholders to assist with data-related technical issues and supports their data infrastructure needs.

- Collaborate with business users, external vendors and/or government entities to obtain data requirements for new analytics applications and data feeds or enhancement of existing products. - Uncover appropriate sources of data for proposed application or data warehousing extension profiling data to ensure fitness for business purpose. - Coordinate business requirements for the data and provide consultation to internal stakeholders to support their data needs. - Understand source and target data structures, using standard data tools to review required data and fully profile the data to analyze its ability to meet the business needs. - Complete impact assessments and ad hoc analyses to ensure that production issues and other reported deficiencies are adequately understood and resolved by updating requirements. - Translate requirements into technical requirement specifications, appropriately documenting the solution via Report Specifications, Data Flow Diagrams, and Source to Target (STT) documents. - Act as a senior analyst by directing junior analysts on company protocols, business data, and technical skill. - Create and refine tools and workflows to efficiently collect and translate organizational data and reporting needs.

- Collaborate with business users, external vendors and/or government entities to obtain data requirements for new analytics applications and data feeds or enhancement of existing products. - Uncover appropriate sources of data for proposed application or data warehousing extension profiling data to ensure fitness for business purpose. - Coordinate business requirements for the data and provide consultation to internal stakeholders to support their data needs. - Understand source and target data structures, using standard data tools to review required data and fully profile the data to analyze its ability to meet the business needs. - Complete impact assessments and ad hoc analyses to ensure that production issues and other reported deficiencies are adequately understood and resolved by updating requirements. - Translate requirements into technical requirement specifications, appropriately documenting the solution via Report Specifications, Data Flow Diagrams, and Source to Target (STT) documents.