Health Services Clinical Configuration Analyst

Wellmark, Inc.•Des Moines, IA

13d•Remote

About The Position

As a Health Services Clinical Configuration Analyst, you will join Wellmark’s Health Services Business Support team in a highly consultative, clinically driven role where your expertise directly shapes how our teams support members who need care. In this position, you’ll apply deep clinical and care management knowledge to analyze and improve UM business workflows, including clinical assessments, rules, and documents, while validating Health Services programs against business requirements and acceptance criteria. You will also partner closely with medical directors and cross‑functional teams to review, evolve, and update InterQual and custom clinical criteria, ensuring Wellmark’s medical policy is thoughtfully translated into our UM systems. Success in this role comes from strong critical thinking skills applying clinical expertise, collaboration, analytical thinking, and the ability to translate clinical business changes into efficient, well‑designed processes and opportunities for automation and innovation. Experience working in Agile environments is a plus. Candidates willing to come onsite to our Des Moines, Iowa office at least 2 days each week (your choice on days) to align with business needs and the Product Team schedule are preferred. Registered Nurse (RN) is also highly preferred.

Requirements

Bachelor’s degree in related field or direct and applicable work experience.
A minimum of 4 years of diverse experience in a health care, health insurance, or similar work environment. Experience must reflect one or more of the following: Direct clinical care to the consumer, health and care management or related program experience. Strong understanding of the health care industry, including compliance or accreditation standards – e.g., DOL, URAC, NCQA, state insurance requirements, advanced health care management programs utilizing data analysis, identifying shifts in customer needs/expectations, state/federal mandates, etc.
At least 1 year of business and systems analysis experience using a variety of detailed business requirements elicitation techniques and documentation.
Strong analytical skills with the ability to influence and lead others to appropriate decisions relative to data analysis and process improvements.
Must be able to understand complex processes and promote change in accordance with applied understanding of business requirements.
Strong process improvement skills with ability to define, facilitate and support the implementation of health care program improvements by working with cross-functional teams and stakeholders.
Strong written and verbal communication skills, including the ability to develop and facilitate presentations. Must be able to effectively communicate complex information with varied internal audiences.
Effective analytical, critical thinking and troubleshooting skills.
Basic technical acumen with the ability to learn new systems quickly.
Attentive to details. Demonstrated commitment to accuracy and quality.
Proactive self-starter with effective time management skills and the ability to independently organize and prioritize projects or tasks. Flexible and adaptable to change.
Proficient with Microsoft Office applications.

Nice To Haves

Active and unrestricted Registered Nurse (RN) license in Iowa or South Dakota (individual must be licensed in the state in which they reside).
Ability to retrieve and analyze data using Excel and SQL.
Exposure to health services systems (e.g., Jiva) including system configuration.
Ability to coach and mentor others.

Responsibilities

Evaluate and validate Health Services program activities against business requirements and acceptance criteria.
Perform routine analysis of business requirements, user stories, and acceptance criteria to ensure documentation is accurate, clear, and complete.
Assess business requirements to identify any gaps.
Analyze Health Services processes and use cases against other like plans and out-of-the-box system capabilities to foster ideation of new and/or enhancements to existing business processes and requirements.
Apply clinical knowledge and experience to provide functional, configuration and analytical support for product team activities and initiatives, ensuring adherence to deliverables and timeframes as applicable.
Build and maintain constructive, interactive relationships with stakeholders and vendors providing effective consultation, guidance and recommendations based on industry knowledge and compliance requirements to facilitate tactical expansion and service improvements.
Build and maintain an understanding of vendor roadmaps of planned application changes and enhancements.
Participate in vendor- led working groups as available to champion for future out-of-the-box enhancements that will support Health Services business capabilities.
Ensure processes, workflows and functional system documentation are accurate, complete, and updated with changes communicated regularly and as appropriate.
Actively participate and/or lead product ceremonies (as assigned), including refinement sessions and demos for new capabilities and/or enhancements.
Identify the need to create and maintain documentation to support of operational reporting needs (e.g., system administrator reports, error logs).
Collaborate with and support System Configuration Analyst(s) in the configuration and/or troubleshooting of business code tables and rules, correspondence engine and templates, workflows and system roles/permissions supporting the business processes and requirements, especially when clinical expertise is beneficial.
Collaborate with and support product team members in the design and writing of user stories and acceptance criteria test cases to verify solution adherence to business requirements.
Support defect analysis during test execution as required.
Work collaboratively with the product team to support identification of root cause and resolution.
Collaborate with Business Development on research and analysis of vendor service strategies to support Health Services (e.g., Point Solutions).
Comply with regulatory standards, accreditation standards and internal guidelines; remain current and consistent with the standards pertinent to Health Services.
Other duties as assigned.