Senior Provider Reimbursement & Data Strategy Analyst

Wellmark-Blue-Cross-and-Blue-Shiel; Des Moines (IA); Hybrid; USD 95,000 - 130,000; Full time

Job summary

Wellmark Blue Cross Blue Shield in Des Moines, IA, seeks a Senior Network Economics Analyst to lead provider reimbursement strategies and financial reporting for Wellmark-contracted providers. You will mentor teammates, influence payment policy decisions, and build solid relationships with internal stakeholders while guiding long-term reimbursement initiatives.

You will analyze claims data, interpret utilization trends and communicate insights to leadership.

Qualifications

• Bachelor's degree or equivalent experience in a business/finance field.
• 7+ years in health insurance or healthcare with financial analysis experience.
• Proficiency with Excel; experience with Power BI/Tableau/SAS EG/SQL.
• Knowledge of provider payment, contracting, and claims processes.
• Experience interpreting claims data and provider utilization for pricing.

Responsibilities

• Lead, design, implement and maintain provider reimbursement strategies and related financial reporting.
• Perform advanced data analysis to support reimbursement initiatives and pricing recommendations.
• Consult with Network Economics and Health Network stakeholders on policy decisions.
• Provide reimbursement guidance and payment policy input to providers and stakeholders.
• Coordinate data transfers in provider payment systems and collaborate on system enhancements.
• Manage service levels with provider payment vendors and vendor relationships.
• Perform additional duties as assigned.

Skills

Provider reimbursement strategies

Data analysis

Advanced Excel

Power BI

SQL

Contracting knowledge

Presentation skills

Education

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

Tools

Power BI

Tableau

SAS EG

SQL

Job description

Wellmark Blue Cross Blue Shield in Des Moines, IA, seeks a Senior Network Economics Analyst to lead provider reimbursement strategies and financial reporting for Wellmark-contracted providers. You will mentor teammates, influence payment policy decisions, and build solid relationships with internal stakeholders while guiding long-term reimbursement initiatives.

You will analyze claims data, interpret utilization trends and communicate insights to leadership.