Job Description

Company Description

Internal Job Title: Network Innovation Analyst

Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we\xe2\x80\x99ve built our reputation on over 80 years\xe2\x80\x99 worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors\xe2\x80\x93our members. If you\xe2\x80\x99re 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!

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The health care industry is evolving and Wellmark is working to help change it for the better. Help us lead the change as we add a crucial position to our Network Analytics Team at Wellmark!

About the Role: While supporting the Medicare Advantage, Provider Payment Strategy and Provider Performance teams, you will deliver strategic analysis, Medicare stars & risk adjustment data reporting, value-based data reporting and consulting to health care organizations, Wellmark leadership, and internal stakeholders. You will leverage data from multiple internal and external sources to develop and deploy successful comprehensive provider network payment and value-based payment strategy initiatives to provide actionable recommendations as it relates to provider network payment strategy, medical cost and quality. While adhering to established data governance standards and processes, you will analyze, research, assess, document, monitor and implement new network payment strategy and value-based payment models, as well as improve and/or maintain existing value-based models. You will also support health care organization reimbursement initiatives by designing, implementing and maintaining health care organization compensation strategies.

About You: You are inquisitive and focused on making data-driven conclusions, decisions and recommendations to achieve business goals. You feel effective when you can extract, analyze, interpret and integrate data to monitor and implement strategic, innovative programs and initiatives. In addition, you have a thorough understanding of contracting, claims payment procedures and payment policy. You have strong written and verbal communication skills that aid you in consulting, collaborating and effectively communicating complex concepts to varied audiences. Medicare Advantage experience is a must for this role!

This position will work a hybrid schedule of at least 3 days in a Wellmark office, with 2 days remote option.

Qualifications

Required:

• Bachelor\'s degree or direct and applicable work experience.
• 3+ years of experience pulling reports, analyzing, and interpreting complex data \xe2\x80\x93 e.g., clinical outcomes, claims data, utilization trends, etc. Ability to interpret and integrate data, or perform statistical analyses and data modeling techniques.
• 1+ year of health insurance, health care, or related industry experience.
• Proficiency with Microsoft Office applications, including Excel. Ability to create or customize ad hoc reports and knowledge of formulas, vlookups, linking spreadsheets or data sources, data summarization/visualization, etc.
• Strong consultation, relationship management, and critical thinking skills. Ability to develop business acumen and ask meaningful questions to effectively consult with stakeholders.
• Strong written and verbal communication skills with the ability to communicate complex concepts to varied audiences. Ability to develop and deliver presentations.
• Attention to detail, including the ability to collect, monitor, and assess the accuracy, validity, and integrity of information/data.
• Ability to coach and educate stakeholders on complex, technical subjects.
• Valid Driver\xe2\x80\x99s License with intermittent travel, less than 5%.

Additional Information

a. Provide actionable data and recommendations to health care organizations as it relates to medical cost and quality. The Analyst will collaborate with the Network Payment Strategy and Network Performance teams and will meet with key health care organizations to review performance and drive action plans that achieve quality and total cost of care financial performance.

b. Develop opportunity projections and determine the viability of various opportunities to support strategic decision making as it relates to cost of care, efficiency, and quality and drive Wellmark\xe2\x80\x99s value proposition to stakeholders.

c. Extract, analyze, interpret and integrate data using internal and external data sources to develop initiatives, support recommendations and draw conclusions to internal and external stakeholders to achieve business strategies and goals.

d. Ensure data integrity by performing quality assurance checks for vendor reporting. Will collaborate with other analysts to conduct monthly verification of the vendor dashboards.

e. Maintain collaborative relationships with internal and external stakeholders, including health care organizations and vendors, to communicate Wellmark\xe2\x80\x99s value-based payment strategy and present utilization, financial and clinical information clearly and accurately.

f. Support the Network Performance team in creating and maintaining relationships with provider groups by identifying, initiating and establishing appropriate internal and external contacts and sources needed for information sourcing.

g. Support stakeholders in monitoring progress towards goals by demonstrating the comprehensive impact of recommendations (e.g., illustrate and explain results of return on investment and/or program evaluation analyses).

h. Support Network Payment Strategy and Network Performance initiatives by documenting and monitoring value-based health care organization payment initiatives.

i. Perform routine analysis for Wellmark leadership to monitor payment methodologies for effectiveness. Apply qualitative and quantitative techniques to interpret provider payment data, identify opportunities and provide recommendations as appropriate.

j. 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

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