Sr Network Economics Analyst

About Wellmark

Wellmark is a mutual insurance company owned by policyholders across Iowa and South Dakota, built on over 80 years of trust. We are driven by the well-being of our members, not profits. If you are passionate about putting members first, providing best-in-class service, and are committed to sustainability and innovation, consider applying.

About the Role

As a Sr Network Economics Analyst (internally known as Sr Network Economics Analyst), you will lead, design, implement, and maintain provider reimbursement strategies, including financial reporting for all Wellmark-contracted providers and multi-year agreements. This involves applying a thorough understanding of contracting, claims payment procedures, and payment policy. Collaboration is key; you will build and maintain strong business relationships with other Health Network team members at Wellmark to enhance provider support. As a senior team member, you will mentor colleagues and serve as the subject matter expert, making recommendations to leadership on strategic and payment policy decisions.

About You:

You are a critical and strategic thinker, detail-oriented, and highly analytical. You excel at conceptual thinking, anticipating long-term outcomes, and identifying continuous improvement opportunities in provider reimbursement. You leverage advanced data analysis experience and a consultative approach to make recommendations and partner with internal business leaders. You are skilled at creating and communicating insights from data to effectively tell the story. Additionally, you enjoy educating and mentoring peers to build their analytical skills and strategic provider reimbursement knowledge.

• Hospital and/or health care facility reimbursement experience is preferred.
• Top candidates will have experience with PowerBI, Tableau, SAS EG, and/or SQL.
• Candidates currently residing in the Des Moines, IA metro area are preferred.
• Work Schedule: This position operates on a hybrid schedule, requiring at least 3 days per week in Wellmark’s Des Moines office (Tuesday-Thursday), with the option for remote work on Mondays and Fridays.

Qualifications:

Preferred Qualifications (Great to have):

• Technical proficiency with tools such as: Power BI, Tableau, SAS EG, and/or SQL.
• Ability to serve as a subject matter expert to mentor team members.
• Strong presentation skills and the ability to clearly articulate recommendations to business leadership to achieve business results.

Required Qualifications (Must have):

• Bachelor’s degree in Accounting, Finance, Business, Economics, or a related field, OR direct and applicable work experience.
• 7+ years of relatable experience within the Health insurance industry, including:
• Demonstrated experience performing financial analysis and data modeling in a healthcare setting.
• Solid knowledge of and demonstrated ability in Microsoft Excel (including superior ability in using Excel Macros, Advanced Formulas, and Pivot Tables).
• Previous experience in a healthcare, finance, or related field (e.g., hospital or physician office, or a role supporting job-specific competencies).
• Knowledge of hospital, physician, and other provider payment and contracting strategies.
• Demonstrated knowledge of the health insurance industry, including delivery systems and managed care concepts; thorough understanding of reimbursement, contracting, claims processing, and medical policies.
• Experience interpreting claims data, trends, and provider utilization to determine payment strategy or assess payment strategy results.
• Demonstrated ability to foresee issues before being 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 draw conclusions.
• Strong analytical skills and proven problem-solving ability with a record of independent problem identification and resolution.
• 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 to apply strong analytical, conceptual, and strategic thinking skills to negotiate with providers or their representatives.

Additional Information:

What You Will Do:

• Lead, design, implement, and maintain provider reimbursement strategies, including financial reporting for all providers. Research, document, monitor, and implement provider reimbursement-related activities and initiatives.
• Perform advanced data analysis and provide insights to support provider reimbursement initiatives. Apply qualitative and quantitative techniques to interpret provider data and provide pricing recommendations.
• Consult with and provide subject matter expertise to Network Economics, Health Network, and other Wellmark business stakeholders regarding recommendations and enhancements to provider payment strategies and payment policy decisions.
• Serve as a consultant in collaboration with Network Engagement to provide reimbursement guidance/expertise and payment policies to providers and applicable stakeholders.
• Configure, transfer, and monitor data processed in provider payment systems. Collaborate on testing and system implementations and enhancements. Provide business knowledge and payment processing expertise for projects.
• Collaborate, interface, and manage all service level agreements and relationships with provider payment vendors.
• Other duties as assigned.

Equal Opportunity Employer

Wellmark Blue Cross Blue Shield is an equal opportunity employer. We recruit, hire, train, and promote individuals 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 reasonable accommodation due to a disability should contact [email protected]. Wellmark does not consider applicants requiring immigration sponsorship. Wellmark supports the responsible use of AI in the workforce.