Provider Engagement Associate Consultant

Wellmark, Inc.•Des Moines, IA

1d•Hybrid

About The Position

As a Provider Engagement Associate Consultant, you will support the development and maintenance of strong, collaborative relationships with health care organizations participating in Wellmark’s networks. In partnership with Provider Engagement leadership and Provider Engagement Consultants (PECs), you will increase provider engagement capacity and serve as the primary engagement and relationship owner for assigned provider segments. You will do this through operating within Wellmark's provider support model to deliver a differentiated engagement approach based on provider impact, complexity and risk. In addition, you will execute tier-based engagement strategies, and own complex provider issues and engagement activities that require independent judgment, cross‑functional coordination, and proactive communication. You will act as an extension of the PEC team, enabling PECs to focus on enterprise‑level strategy and priority initiatives while ensuring consistent, high‑quality engagement across the broader provider population. Lastly, you will operate with delegated authority to independently manage provider relationships, resolve complex operational issues and deliver a differentiated engagement approach.

Requirements

Bachelor’s degree or direct and applicable work experience.
Minimum of 3 years of progressive experience in a health care, health insurance, or related environment, with experience in one or more of the following areas: provider relations, reimbursement, credentialing, contracting, claims payment, medical policy, customer or provider services, or operational support roles.
Demonstrated ability to build and maintain positive working relationships with external providers (e.g., physicians, hospitals) and internal stakeholders across multiple departments.
Strong verbal and written communication skills, including the ability to clearly explain complex concepts and deliver presentations to both small and large audiences, internally and externally.
Demonstrated subject matter expertise or working knowledge of provider facing systems and processes, including the ability to analyze inquiries, determine appropriate resolution paths, and coordinate with subject matter experts.
Strong analytical, problem solving, workflow, and critical thinking skills, with the ability to manage multiple priorities and projects in a fast paced environment.
Ability to operate independently while collaborating effectively within cross functional teams to support shared goals and timelines.
Proficiency with Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint.
Strong organizational, time management, and prioritization skills, with the ability to adjust to changing business needs.

Nice To Haves

Experience working with claims processing and inquiry systems, provider credentialing and contracting workflows, or contact/engagement management systems.
Experience in roles that emphasize relationship management, strategic consultation, or provider engagement, including face to face interactions with health care organizations.
Demonstrated ability to influence and consult with stakeholders at varying levels of an organization to support adoption of initiatives and resolution of complex issues.
Experience analyzing qualitative and quantitative data (e.g., claims, operational, or quality data) to identify trends, support decision making, or inform provider engagement strategies.
Experience supporting pilots, programs, or new initiative rollouts within a health care or health insurance environment.
Ability to develop and maintain documentation of processes, procedures, and operational tools while following established guidelines.

Responsibilities

Serve as the accountable relationship and operational owner for complex provider issues within assigned provider segments, determining resolution strategy, cross functional stakeholder engagement and escalation thresholds.
Maintain positive, collaborative relationships between Wellmark and in network providers that do not have an assigned Provider Engagement Consultant—primarily smaller/non strategic providers— serving as a primary engagement contact and routing strategic/complex needs to PECs or leadership per guidelines.
Increase provider engagement and satisfaction through consistent, proactive communication, outreach (education, reminders, updates), and timely issue resolution, including leading virtual meetings as appropriate to address complex or escalated provider concerns.
Act as an extension of the Provider Engagement Consultant team by supporting relationship management activities, follow ups, and provider engagement efforts.
Provide subject matter expertise on provider facing systems and operational processes, which may include credentialing, claims, utilization management, and medical policies, to support effective inquiry and escalation resolution.
Document, triage, track, and manage provider escalations through the Network CRM or related engagement systems, ensuring accurate documentation, follow through, and data integrity. Adhere to CRM documentation standards for assigned segments; validate case taxonomy, trend tagging, and closure codes to enable reliable reporting and insight.
Analyze provider escalations, consult with appropriate subject matter experts, determine recommended resolutions, and clearly communicate outcomes to providers and internal partners.
Proactively educate providers during engagement and issue resolution to promote self service tools and resources (e.g., Check a Claim Tool, Authorization Table, Provider Guides), track uptake where feasible, and reduce repeat inquiries to improve the provider experience. Partner with provider communications owners to inform segmentation, targeting, and content needs for assigned provider audiences; provide field intelligence and validate clarity/actionability.
Monitor and analyze trends in escalated inquiries, provider training needs, and recurring pain points; document themes and coordinate closed loop follow up with internal stakeholders to inform improvements. Create and maintain recurring segment insight summaries (e.g., top drivers of friction, repeat inquiry drivers, self-service adoption barriers) and translate into prioritized improvement recommendations for internal partners.
Provide high level operational and engagement support for Provider Engagement initiatives, pilots, programs, and new provider facing rollouts, including supporting provider communications, webinars, or job aids to promote change readiness.
Participate in and deliver provider and internal education sessions as assigned by leadership.
Accountable for measurable outcomes within assigned provider segments, including provider experience, escalation volume, timeliness of issue resolution, reduction in repeat inquiries and adoption of self-service tools.
Other duties as assigned.