Team Leader - Provider Payment Analytics (Network Economics)

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

Use your strengths as Team Leader of Provider Payment Analytics at Wellmark!

About the Role: As a Team Leader, you will lead a multi-functional team that is accountable for the design, implementation, and maintenance of fee-for-service payment methodologies, including system processing solutions for all Wellmark contracting network providers.

In this highly visible role, you will work cohesively and collaboratively across the Health Care Innovation division, as well as with other internal and external stakeholders, to ensure provider payment, project objectives, expected deliverables and goals are implemented accurately and timely. This role will have a seat at the table in collaborating on and leading initiatives focused on Wellmark's Total Cost of Care strategy.

About You: Because this role is a leader of others, this individual will directly impact the success, growth, and development of team members by establishing goals and objectives, setting clear expectations, defining accountabilities, providing regular coaching, facilitating change, and providing an overall positive work environment.

Being a role model in behaviors that demonstrate Wellmark's core competencies is a must. In addition to a passion for developing others, our ideal candidate is skilled at change leadership; effectively managing change will be critical from establishing the business case for change, to operationalizing and communicating evolving business processes both internally and externally. You will be skilled in analysis, health care organization strategy development and negotiation and able to influence the changes needed to support business strategies, while utilizing your health care organization contract experience to drive impactful results across the team.

Experience with business intelligence and analytics platforms, such as Power BI preferred.

This position will work a hybrid schedule of at least 3 days in Wellmark's Des Moines office, with 2 days remote option. As a leader, there may be additional days in office to meet business needs.

Internal Title: Team Leader, Network Economics

Qualifications

Required:

• Bachelor's degree in business, accounting, finance or related field, or direct and applicable work experience.

• 4+ years related work experience:

• In health care administration, health insurance, or related industry experience that demonstrates knowledge of claim submissions/forms, provider contracting, pricing, billing, reimbursement, etc.; provider payment experience is strongly preferred.

• Participating in or leading projects/initiatives. Demonstrates key drivers of project management effectiveness.

• Strong technical, analytical, and diagnostic problem-solving skills, attention to detail, and desire to maintain customer and stakeholder satisfaction.

• Thinks creatively, strategically, and uses data to drive positive outcomes and improvements.

• Effective leadership experience in a formal or informal (e.g., program or project) leadership role. Ability to lead a diverse team through change.

• Proactive self-starter with effective time management and prioritization skills. Successfully manages and tracks projects.

• Excellent verbal and written communication skills, including the development and delivery of presentations or provider communications. Effectively communicates with diverse internal/external audiences, including executive leadership, and is able to negotiate, influence decisions, and facilitate group discussions.

• Collaborative approach with ability to partner with different business areas to produce results.

• Proficiency with Microsoft Office, including Excel, Word, and PowerPoint. Technical aptitude to learn systems quickly.

• Ability to travel (<5%) as needed.

Preferred:

• Bachelor's degree in business, accounting, finance or related field.

• Formal leadership experience.

Additional Information

Job Responsibilities:

a. Provide leadership and day-to-day management of financial and human resources, primarily focusing on employee coaching, development, performance improvement, coordination and budgeting for staff and department(s) specific functions/services.

Support business objectives and produce results that are effective, accurate, timely, and on target to meet business and stakeholder needs. Identify, monitor, and communicate critical business metrics to ensure project execution success and leverage results for future process improvements.

b. Analyze payment data to identify trends and make recommended changes to processes/policies and system design. Stay abreast of health care industry related to payment and incorporate findings into strategic plans as appropriate.

c. Serve as a subject matter expert of Wellmark's provider payment and technical systems. Provide strategic consultation for the development, implementation, and maintenance of effective health networks.

d. Collaborate with key internal stakeholders and external vendor partners to develop, implement, and maintain provider payment methodologies, tools, and technical systems. Ensure all technical systems are synchronized and provider payment is in compliance with contractual obligations.

e. Manage and implement projects by managing interdependencies, interrelationships, requirements and solutions of multiple projects and systems. Leverage business resources effectively by continually supporting system development life cycle (SDLC) and the facilitation/coordination of multiple project schedules from a business and system perspective to ensure timelines and mandated dates are met.

f. Consult with externally facing divisions, including Network Engagement and Sales, to provide strategic consultation related to provider payment, technical systems, communications, and inquiry resolution. Meet directly with providers as appropriate in designing and implementing strategic payment models, evaluating additional network services, and negotiating appeals and single case agreements.

g. Lead process improvement endeavors within the Network Economics department to initiate and implement improvements that support department and division goals. Ensure process improvement opportunities incorporate industry & market knowledge (best practices, pricing methodology, etc.).

h. Participate in division level strategy and structural development to support requirements relating to network payment and technical solutions.

i. Manage business relationships and day to day interactions with multiple vendor partners simultaneously. Ensure the desired programs and/or services are delivered based on agreed upon service level agreement standards and delivery expectations are met.

j. Other duties as assigned.

This job requires a non-compete agreement.

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 careers@wellmark.com