Provider Data Manager

Job Description

Job Description

Company Description

Why Wellmark : We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!

Learn more about our unique benefit offerings here.

Want to know more? You can learn about life at Wellmark here.

Job Description

In this role, you will lead strategic efforts to ensure the accuracy, integrity, and usability of provider data within the provider data management ecosystem. You’ll serve as a subject matter expert in provider data management, credentialing, and payment systems, translating complex data initiatives into actionable strategies that support compliance with Blue Cross and Blue Shield Association (BCBSA), regulatory, and business requirements.

You will oversee provider data operations, manage vendor relationships, and collaborate with cross-functional teams to drive data quality improvements. Your leadership will be key in aligning provider data with enterprise goals, ensuring it supports operational efficiency, regulatory compliance, and a seamless provider and member experience.

Qualifications

Required :

• Bachelor's degree in related field or direct and applicable work experience.
• Minimum of 3 years experience in Provider Credentialing or applicable work.
• Experience and proficiency with Excel and Business Objects or equivalent tools.
• Ability & willingness to serve as department SME on cross-functional teams.
• Highly effective analytical skills, business intuition, and demonstrated proficiency with large, complex data sets and distilling large amounts of information into the most relevant insights.
• Ability to apply critical thinking skills, problem solving, and troubleshooting skills to analyze and problem solve data gaps and information requests and recommend strategies for monitoring business enhancements.
• Strong verbal and written communication skills with the ability to articulate provider data solutions to internal and external stakeholders.
• Ability to build and sustain relationships with stakeholders and business partners.
• Ability to manage multiple activities or projects and is flexible and adaptable to changing priorities.
• Ability to hold vendors accountable to expectations and effectively manage KPIs and SLAs.

Preferred :

Additional Information

a. Utilize data from Network Administration and provider data partner sources to maintain provider data integrity, functionality, and requirements. Collaborate with Team Leaders and other business partners to track and correct any issues.

b. Interpret and summarize relevant data from multiple sources to conduct comprehensive, collaborative analysis. Produce concise compilation of the analysis, providing implications and recommendations as appropriate to key decision makers.

c. Understand changes to regulations and compliance requirements that would impact Provider Data Accuracy. Support leadership in communicating these changes to team members, vendors, and business partners.

d. Build relationships and effectively manage relationships with vendor(s) supporting the Provider Data Accuracy ecosystem. Communicate to them any new or revised requirements and ensure effective implementation. Monitor and manage applicable SLAs and KPIs.

e. Maintain collaborative relationships with other internal stakeholders across the organization including the Product team, Operations Business Support team, Network Contracting and Technology to ensure business needs are met and provider data is communicated clearly and accurately.

f. Support adherence to compliance and regulation by providing complete and accurate data extracts and data reporting as requested by NCQA, CMS, TriWest, and other auditors.

g. Represent Network Administration as a provider data expert in enterprise projects. Communicate project goals, system and process changes, timelines, and outcomes with leadership.

h. Collaborate within and outside of Operations to coordinate and drive Administration Program Increment (PI) planning deliverables.

i. 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 at careers@wellmark.com

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

At this time, Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States. This includes, but IS NOT LIMITED TO : F1-OPT, F1-CPT, H-1B, TN, L-1, J-1, etc. For additional information around work authorization needs please refer to the following resources : Nonimmigrant Workers and Green Card for Employment-Based Immigrants