Sr Network Performance Analyst – Medicare Advantage

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. 

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 add a crucial position to our Medicare Advantage Network Performance Team at Wellmark! 

About the Role: This newly created role will function as a consultative and collaborative analyst. While supporting the Medicare Advantage Network team, you will design, implement and maintain provider and plan performance strategies. This includes financial, risk and quality data/reporting for providers. You will perform advanced data analysis and insight in support of plan and network performance. Also, you will serve as a Subject Matter Expert (SME) to internal teams and will take the lead on making recommendations in support of strategic and program performance decisions. Lastly, you will work closely with division leadership to align network and plan performance with corporate objectives and 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. You have strong written and verbal communication skills that aid you in consulting, collaborating, and effectively communicating complex concepts to varied audiences, especially non-technical stakeholders. You enjoy thinking critically and taking the initiative to try something new without fear of failure (we fail forward!). SQL experience is a must, but you are excited to balance these technical skills with your strong communication and collaboration skills. 

Internal Job Title: Sr Government Programs Network Performance Analyst 

This position will work a hybrid schedule of at least 3 days in a Wellmark office (Tues-Thurs), with 2 days remote option (Mon and Fri).  

Qualifications

Required Qualifications - Must have:

• Bachelor's degree in business, healthcare administration, or related field, or direct and applicable work experience
• 5+ years of health insurance, health care, or related industry experience, including the following:
  • Demonstrated experience performing analysis and data modeling in a healthcare setting
  • 1+ years direct and applicable work experience with specific experience in the analysis of databases and files using SQL dialects and statistical programming languages with specific experience utilizing data collection, advanced formulas, advanced joins, analysis.
• Solid knowledge of and demonstrated ability in Microsoft Excel (including superior ability in the use of Advanced Formulas and Pivot Tables).
• Previous experience in a healthcare, finance or related field, (i.e. hospital or physician office or experience in a position that supports the job specific competencies noted)
• Demonstrated knowledge of the health insurance industry including delivery systems and managed care concepts; thorough understanding of reimbursement, claims processing, risk adjustment and quality (HEDIS).
• Experience interpreting claims data, trends and provider utilization in order to determine performance strategy
• Demonstrated forethought of issues before questioned; ability to research, ask questions and find solutions to potential problems
• Demonstrated problem-solving, quantitative and analytical skills; ability to recognize inconsistencies, analyze for reasonableness and accuracy, research and come to conclusions
• Strong analytical skills and proven problem solving ability with a proven record of independent problem identification and resolution skills
• Comprehensive knowledge of nationally recognized provider compensation strategies
• Strong attention to detail (timeframes, resources, parties involved, communication, etc.) in developing and implementing action plans   
• Demonstrated ability applying strong analytical, conceptual and strategic thinking skills to negotiate with providers, or the organizations representing them

Preferred Qualifications - Great to have