Wellmark Blue Cross and Blue Shield

Analyst

• Join Wellmark’s Health Services Business Support team in a consultative, clinically driven role
• Apply deep clinical and care management knowledge to analyze and improve UM business workflows
• Validate Health Services programs against business requirements and acceptance criteria
• Partner with medical directors and cross‑functional teams
• Review and evolve InterQual and custom clinical criteria
• Ensure Wellmark’s medical policy is translated into UM systems
• Evaluate and validate Health Services program activities against business requirements
• Analyze Health Services processes and foster ideation of new or enhancements to existing business processes
• Build and maintain constructive, interactive relationships with stakeholders and vendors

Health Services Clinical Configuration Analyst

• Provide clinical leadership and subject-matter expertise to support the analysis, configuration, and administration of complex medical policy content within claims processing systems, including Plan General Exclusion (PGE) rules and FACETS table maintenance.
• Ensure the accurate implementation of medical policies, review criteria, and authorization requirements, while maintaining the integrity of system infrastructure and serving as a key liaison between business and technical teams.
• Research and analyze system and business issues, develop high-level requirements, test and implement solutions, and audit and document outcomes.
• Serve as an expert resource for medical policy configuration and PGE coding, mentoring and training Coding Specialists, and providing policy-related training and support to operational partners such as customer and provider services.
• Maintain coding integrity by monitoring utilization trends to identify and resolve system configuration issues.
• Mentor and train Coding Specialist as well as provide specific topic training related to medical policy administration/PGE rules to other operational areas such as customer and provider service as needed.

Health Services Coding Analyst, CPC Required

• Provide clinical leadership and subject-matter expertise to support the analysis, configuration, and administration of complex medical policy content within claims processing systems, including Plan General Exclusion (PGE) rules and FACETS table maintenance.
• Ensure the accurate implementation of medical policies, review criteria, and authorization requirements, while maintaining the integrity of system infrastructure.
• Serve as a key liaison between business and technical teams.
• Research and analyze system and business issues, develop high-level requirements, test and implement solutions, and audit and document outcomes.
• Serve as an expert resource for medical policy configuration and PGE coding, mentoring and training Coding Specialists, and providing policy-related training and support to operational partners such as customer and provider services.
• Must be willing to work core business hours of 8 AM - 5 PM Central Time.

• Provide clinical leadership and subject-matter expertise to support the analysis, configuration, and administration of complex medical policy content within claims processing systems.
• Ensure the accurate implementation of medical policies, review criteria, and authorization requirements, while maintaining the integrity of system infrastructure and serving as a key liaison between business and technical teams.
• Research and analyze system and business issues, develop high-level requirements, test and implement solutions, and audit and document outcomes.
• Serve as an expert resource for medical policy configuration and PGE coding, mentoring and training Coding Specialists, and providing policy-related training and support to operational partners such as customer and provider services.
• Must be willing to work core business hours of 8 AM - 5 PM Central Time.
• Collaborate with Utilization Management nurses, medical directors, and claims teams to resolve coding-related denials, overrides, and policy interpretation questions.
• Contribute to the full lifecycle of medical policy creation, revision and interim review, including drafting coding sections, researching emerging procedures/devices, and ensuring policies reflect current coding conventions.

Health Services Coding Analyst

Full-stack Engineer

• Lead full stack development for the Digital Services team, performing detailed systems analysis and implementation of high performing software solutions that are efficient and cost effective, supporting Wellmark’s business and Technology applications.
• Lead system development and guides the team in the design, development, code testing and debugging necessary to ensure successful completion or resolution of issues while focusing on utilization of emerging technologies.
• Orchestrate cross-functional end-to-end execution across diverse platforms, all meticulously aligned with Wellmark's SDLC standards and the structured SAFe methodology in order to culminate the making of these advancements accessible and beneficial to all Information Product teams and foster a unified and elevated approach to development and delivery.
• Work closely with UX/UI designers, product managers, Architects and DevOps engineers to create responsive, interactive, and high performing applications by delivering high quality code that ensures a seamless user experience across multiple devices.
• Develop and optimize web pages for maximum speed, accessibility and scalability.
• Develop and optimize backend architecture ensuring scalability, performance and security.
• Write clean, maintainable and efficient code, adhering to best practices and Wellmark engineering standards.
• Ensure mobile responsiveness of applications.
• Ensure analysis of defects to find root cause and guide others in the identification of potential improvement opportunities.
• Provide production support of applications including root cause analysis and break-fix resolution.
• Use data and cost measures (AWS, infrastructure, labor, etc.) to influence timely decisions, build consensus, and take actions to successfully deliver project or production support objectives and support benefits realization.
• Identify known issues, impacts to project or production outcomes if not resolved and escalate as necessary.
• Contribute to a collaborative agile environment, including PI Planning, iteration planning, estimation, demos and retrospectives.

Senior Full Stack Software Engineer

Consultant

• Wellmark is looking for a highly experienced health care professional with at least 10+ years of experience in the industry
• Translate health care and benefits knowledge into actionable influence
• Leverage their industry network to position Wellmark as a top-tier administrator
• Dedicated focus on broad consultant relations critical to success
• Work closely with Sales Directors, Sales Team Leaders, and SMEs across the business to align strategy and drive impact

National Consultant Relations Executive

• Design, develop, test, implement, maintain, and document software solutions in support of Wellmark’s business strategy and Technology vision
• Ensure completed activities meet project specifications and requirements
• Establish and build working relationships with Technology and business units
• Collaborate with other areas of Technology to ensure solutions improve the user experience
• Participate in determining Technology alternatives and solutions and assist with system integration

Health Services Clinical Configuration Analyst

Health Services Coding Analyst, CPC Required

Health Services Coding Analyst, CPC Required

Health Services Coding Analyst

Senior Full Stack Software Engineer

National Consultant Relations Executive

Software Engineer – Sr. Level