Payments Risk Analyst Jobs in Madison, WI (NOW HIRING)

At Quartz, quality is more than a checkpoint, it's a commitment to delivering exceptional experiences for our members, providers, employers, and internal partners. As a Senior Quality Analyst, you'll play a critical role in protecting operational excellence, ensuring regulatory compliance, and driving continuous improvement across the organization.

This is an exciting opportunity for an experienced analytical professional who enjoys solving complex problems, uncovering opportunities for improvement, and partnering with business leaders to strengthen processes that directly impact on our customers.

As a Senior Quality Analyst, you'll serve as a subject matter expert responsible for designing and executing complex audit strategies that evaluate operational performance, regulatory compliance, and system accuracy. Your work will help identify risks before they impact customers while providing actionable insights that improve business outcomes.

Benefits:

• Opportunity to support and deliver on business initiatives that will positively impact the organization's goals and mission.
• Collaborative work environment with leader that promotes team collaboration and learning
• Starting salary is based upon skills and experience: $66,800 - $83,400 plus robust benefits package

• Design and perform complex operational and compliance audits across multiple business areas, identifying errors and process gaps that may not be detected by operational teams.
• Analyze audit findings to identify trends, perform root cause analysis, and develop recommendations that reduce risk and improve quality.
• Develop comprehensive audit plans by researching business operations, regulatory requirements, and insurance industry guidance.
• Ensure compliance with federal, state, contractual, and organizational requirements through detailed audit reviews.
• Serve as a trusted advisor and subject matter expert for departments throughout the organization, presenting audit findings and leading discussions around process improvements.
• Apply deep knowledge of coding guidelines (e.g., CPT, ICD-10, HCPCS) to evaluate claim accuracy and appropriateness
• Assess and validate provider reimbursement methodologies, including contract interpretation and payment integrity
• Build advanced expertise across multiple business systems and operational processes, including claims, enrollment, customer service, billing, benefits, provider operations, reporting tools, and other enterprise applications.
• Partner with leaders across the organization to strengthen operational processes and improve the overall customer experience.

• Bachelor's or Associate's degree in Finance, Business, Accounting, Health Care Administration, Medical Informatics, or Information Technology or an equivalent field of study
• 4+ years in an analyst position in the healthcare/health plan field.
• Experience with auditing, regulatory compliance, MAR and/or SOX audits.
• Knowledge of business activities, goals and critical success factors that influence systems applications, financial statements and regulatory compliance.
• Advanced ability to perform root cause analysis.
• Advanced skills in data querying tools such as BusinessObjects and modeling tools such as MS Visio.
• Professional certifications in Accounting, Coding, Actuarial Services, or other relevant disciplines preferred.
• Extensive experience with complex claims processing and auditing
• Strong understanding of medical coding standards and guidelines
• Proven knowledge of provider reimbursement methodologies (e.g., fee schedules, DRG/APC, value-based arrangements)
• Excellent analytical, problem-solving, and communication skills
• Ability to work independently while managing multiple priorities in a fast-paced environment

Hardware and equipment will be provided by the company, but candidates must have access to high-speed, non-satellite Internet to successfully work from home.

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. To support a safe work environment, 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 employer. 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 person with disability.