Sr Network Performance Analyst Medicare Advantage

Wellmark, Inc.; Des Moines (IA); Hybrid; USD 70,000 - 95,000; Full time

Job summary

Wellmark is seeking a Sr Government Programs Network Performance Analyst to join its Medicare Advantage Network Performance Team. In this hybrid role, you will leverage data analysis and performance strategies to optimize provider relations and support corporate objectives. Your success will be driven by your ability to communicate complex data insights and collaborate effectively across teams.

Qualifications

• 5+ years in health insurance or related industry.
• Demonstrated experience with data modeling in healthcare.
• Strong ability in analytical skills and problem-solving.

Responsibilities

• Design strategic performance data and analytics.
• Perform advanced data analysis to provide insights.
• Consult with stakeholders to enhance performance strategies.

Skills

Data Analysis

SQL

Communication

Problem Solving

Analytical Skills

Education

Bachelor's degree in business, healthcare administration, or related field

Tools

Microsoft Excel

Microsoft Access

Job description

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:
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:

• Master’s degree.
• Prior experience with forecasting or modeling.
• Experience developing project roadmaps and timelines.
• Strong consultation and presentation skills.
• Have a passion for mentorship and coaching.
• Experience with SAP products including Business Objects.
• Experience with Microsoft Access (including writing, running and modifying queries, joining tables, extracting, updating and exporting data) for analytical purposes.

Additional Information

What you will do:

a. Design, implement and maintain plan and provider performance data, analytics, and tools, including Network Performance provider reporting. Research, document, monitor and implement plan and provider performance related activity and initiatives.

b. Perform advanced data analysis and insight in support of plan and provider performance strategies. Apply qualitative and quantitative techniques to interpret performance data and provide strategic recommendations as appropriate.

c. Consult with and provide subject matter expertise to internal and external stakeholders or partners in the recommendations and enhancements to performance strategies.

d. Serve as the lead analytics partner in collaboration with Network Performance team members to provide performance insights, strategic improvement opportunities, and actionable insights to drive provider performance.

e. Configure, transfer and monitor data that is being transmitted to and from partners, vendors, and providers.

f. Collaborate, interface and support management of the relationship with data and analytics vendors supporting plan or provider performance.

g. Develop proformas and financial models to determine the viability of various opportunities to support strategic decision making related to plan performance and provider performance (e.g. benefit expense, Cost of Care opportunities, coding accuracy, quality performance).

h. 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 goals.

i. Provide peer review and coaching within team and across other business areas.

j. Ensure data integrity by creating processes to ensure quality assurance checks are performed routinely with precision.

k. 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 [e-mail]

Please inform us if you meet the definition of a "Covered DoD official".