Job Description

THE HEALTH CARE INDUSTRY IS EVOLVING AND WELLMARK IS WORKING TO HELP CHANGE IT FOR THE BETTER. HELP US LEAD THE CHANGE AS WE EXPAND OUR SYSTEM CONFIGURATION TEAM AT WELLMARK!

ABOUT THE ROLE: While closely partnering with internal departments, you will be the main driver of defining, reviewing, developing, testing and analyzing business system solutions. As a subject matter expert (SME), you will provide guidance, consultation and recommendations to business stakeholders on strategic initiatives, system reporting and budget in order to implement innovative programs and systems. You will also use your expertise to train and mentor Business Analysts. In addition, you will also ensure compliance standards are met, while confirming member, plan and provider payments are paid timely, accurately and appropriately.

ABOUT YOU: You are a technically strong, self-starter who is intrinsically motivated to ‘dig deep’ to find creative ways to solve problems. You enjoy working autonomously, while also regularly collaborating with your team and other departments to meet business goals. For you, the status quo is something to be challenged in order to find better, innovative ways of working. Top candidates will apply their in-depth Excel knowledge and will have familiarity with Facets and Federal Employee Program (FEP) knowledge. In addition, you have a thorough understanding of plan pricing methodologies and claims pricing/payment. You have strong written and verbal communication skills that aid you in negotiating and influencing others. You thrive on building and maintaining relationships, and partnering with various teams to improve outcomes. An analytic mindset is a must – for you problem solving means getting innovative and anticipating obstacles. If this sounds like you and you’re ready to be a part of making health care better, apply today!

Qualifications

REQUIRED:

•Associate’s Degree or direct and applicable work experience

•Minimum 4+ years of related experience:

   -Techno-functional experience with complex business systems, applications or platforms. Experience combining technical expertise with knowledge of operational business processes demonstrated through elicitation, translation or documentation of business requirements, system testing, etc.

   -Experience and familiarity with Network Economics technical systems – e.g. APR 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

•Ability to analyze and assess business requirements for new or existing system capabilities and contribute to the design and structure of system parameters

•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

•Ability to coach and mentor others through guidance or feedback

Additional Information

a.  Lead, define, review and scrutinize all business requirements for 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.  Plan, lead, develop and test all phases of business system solutions. Coordinate and facilitate strong internal partnerships with the Technology team and vendor personnel, to ensure timing of all technical deliverables/projects (e.g. modifications, interfaces, upgrades, conversions, etc.). Work directly with Technology and Network Economics stakeholders on all projects related to provider payment and payment policies. Support and cultivate department process improvement activities.

c.  Interact and partner with project/program managers to ensure active participation; clarify understanding of high level business needs and requirements on complex projects.

d.   Mentor and train Business Analyst’s as well as team members of provider payments/network economics. Ensure that all are knowledgeable and trained. Identify, troubleshoot and report status and issues to leader.

e.    Validate, analyze, test and compile detailed requirements of multiple platforms, by using a variety of elicitation techniques, understanding business processes, alignment and the technical solutions behind the business requirements.

f.  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.

g.   Collaborate and consult with business stakeholders, as well as members of the Technology team and Network Economics to implement 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.

h.  Provide guidance and thought-leadership to business stakeholders/owners in relationship to strategic initiatives, system reporting and budget.

i.  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 careers@wellmark.com