Company Description
Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!
Learn more about our unique benefit offerings here.
Want to know more? You can learn about life at Wellmark here.
Job Description
Define, review and scrutinize all business requirements for system solutions; new and existing system capabilities. Plan, develop and test all phases of business system solutions. Coordinate and facilitate strong internal partnerships with Technology and vendor personnel, to ensure timing of all technical deliverables/projects (e.g. modifications, interfaces, upgrades, conversions, etc.). Work directly with internal and external stakeholders on all projects related to payment integrity. Support and cultivate department process improvement activities.
Qualifications
Required:
- Associate degree or direct and applicable work experience.
- Minimum 4+ years of related experience in a business analyst, systems analyst, or related role.
- Experience combining technical acumen with knowledge of operational business processes demonstrated through documentation or translation of business requirements, system testing, business process improvement, etc.
- Facets system knowledge and/or experience as well as experience combining technical expertise with knowledge of operational business processes demonstrated through elicitation, translation or documentation of business requirements, system testing, etc.
- Demonstrated familiarity with APR-DRGs and/or EAPG groupers, claims pricing/ payments, etc.
- Strong communications skills (verbal/written) with the ability to articulate complex information or solutions to internal and external stakeholders, including vendors.
- Demonstrated critical thinking, problem solving/troubleshooting and continuous process improvement skills.
- Workflow management skills, including an understanding of sequential progression of tasks or processes and their respective impacts.
- Self-starter with strong time management, organization skills, and the ability to effectively prioritize projects or tasks.
Preferred:
- Advanced level of proficiency with MS Excel.
- Experience consulting with stakeholders
- Exposure to negotiation skills and techniques
- Experience using agile requirements management tools like Azure DevOps
- Experience partnering with global staffing vendors to deliver projects
- Bachelor's Degree
Additional Information
a. Define, review and scrutinize all business requirements for payment integrity related system solutions; monitors and maintains the integrity of the system infrastructure and acts as the subject matter expert (SME) for business and technical requirements.
b. Interact and partner with project/program managers to ensure active participation; clarify understanding of high level business needs and requirements on complex projects.
c. Test all phases of payment integrity related business system solutions. Coordinate and facilitate strong internal partnerships with internal and external stakeholders to ensure timing of all technical deliverables/projects (e.g. modifications, interfaces, upgrades, conversions, etc.).
d. Keep informed support and adhere to regulations, Wellmark’s software development lifecycle (SDLC), operational procedures and other business analysis protocols. Ensure that system conversion and release upgrades are implemented timely with associated business documentation and training prior to the implementation.
e. Work with company resources to accomplish changes to programs and systems. Ensure that processing system infrastructures are kept stable and in compliance with regulating bodies and entities. Assist other business staff in determining best practices for business process improvement.
f. Other duties as assigned.
An Equal Opportunity Employer
The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]
Please inform us if you meet the definition of a "Covered DoD official".
Top Skills
What We Do
Wellmark Blue Cross and Blue Shield and its subsidiaries provide health coverage to more than 2 million members in Iowa and South Dakota. And through the Blue Cross Blue Shield Association, Wellmark is part of a trusted national network that insures more than 100 million people. That's nearly 1/3 of all Americans.
Wellmark offers flexible benefit designs, competitive prices, and a large selection of providers. Nearly all physicians and hospitals in Iowa and South Dakota participate with Wellmark, and the Blue Cross and Blue Shield Association provides extensive national and international coverage.
*Wellmark Blue Cross and Blue Shield is An Independent Licensee of the Blue Cross and Blue Shield Association serving Iowa and South Dakota.
