Sr Data Analyst – Healthcare Economics

Wellmark•Des Moines, IA

1d•Hybrid

About The Position

Also known internally as a Sr Network Economics Analyst, this senior-level role leads, designs, implements, and maintains provider reimbursement strategies, including financial reporting for Wellmark-contracted providers and multi-year agreements. The position applies knowledge of contracting, claims payment procedures, and payment policy to lead reimbursement initiatives and make recommendations on strategic and payment policy decisions. It serves as a subject matter expert, mentors team members, and collaborates with Health Network colleagues and other business stakeholders to support providers and improve reimbursement strategies. The role performs advanced analysis of provider data, claims, trends, and utilization, using qualitative and quantitative methods to develop insights and pricing recommendations. It also provides reimbursement guidance to providers and stakeholders, supports provider-payment system configuration and monitoring, participates in testing and system implementations, and manages relationships and service-level agreements with provider-payment vendors. The position follows a hybrid schedule, with at least three days per week in Wellmark’s Des Moines office (Tuesday through Thursday) and the option to work remotely on Monday and Friday. Candidates currently residing in the Des Moines, Iowa metro area are preferred.

Requirements

Bachelor’s degree in accounting, finance, business, economics, or a related field, or direct and applicable work experience.
At least 7 years of relevant experience in health insurance, healthcare, or a related financial industry, including financial analysis and data modeling; healthcare-setting experience is preferred.
Strong Microsoft Excel knowledge and technical proficiency with tools such as Power BI, Tableau, SAS EG, and/or SQL.
Knowledge of hospital, physician, and other provider payment and contracting strategies.
Knowledge of the health insurance industry, including delivery systems and managed care concepts, and a thorough understanding of reimbursement, contracting, claims processing, and medical policies.
Experience interpreting claims data, trends, and provider utilization to determine payment strategy or evaluate payment strategy results.
Ability to anticipate issues, research questions, and identify solutions to potential problems.
Problem-solving, quantitative, and analytical skills, including recognizing inconsistencies, assessing reasonableness and accuracy, researching, and reaching conclusions.
Comprehensive knowledge of nationally recognized provider compensation strategies.
Strong attention to detail when developing and implementing action plans, including timeframes, resources, parties involved, and communication.
Ability to apply analytical, conceptual, and strategic thinking skills in negotiations with providers or organizations representing them.
Ability to serve as a subject matter expert and mentor team members.
Strong presentation skills and the ability to clearly communicate recommendations to business leadership.
Critical and strategic thinking, attention to detail, and the ability to identify and implement continuous improvement opportunities.
Ability to create and communicate insights from data and collaborate with internal business leaders.

Nice To Haves

Hospital and/or healthcare facility reimbursement experience.
Proficiency in HROR.
Currently residing in the Des Moines, Iowa metro area.

Responsibilities

Lead, design, implement, and maintain provider reimbursement strategies, including financial reporting for providers.
Research, document, monitor, and implement provider reimbursement activities and initiatives.
Perform advanced data analysis and develop insights to support provider reimbursement initiatives.
Apply qualitative and quantitative techniques to interpret provider data and provide pricing recommendations.
Consult with Network Economics, Health Network, and other Wellmark stakeholders on provider payment strategy recommendations and payment policy decisions.
Collaborate with Network Engagement to provide reimbursement expertise and payment-policy guidance to providers and applicable stakeholders.
Configure, transfer, and monitor data processed in provider payment systems.
Collaborate on testing, system implementations, and enhancements, providing business and payment-processing expertise as applicable.
Manage service-level agreements and relationships with provider-payment vendors.
Mentor team members and serve as a subject matter expert.
Perform other duties as assigned.