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! 

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Internal Wellmark Job Title: Team Leader, Network Administration

Use your strengths as Team Leader of Network Administration! 

About the Role: As a Team Leader, you will lead a multi-functional team that is accountable for supporting the development of Wellmark’s provider credentialing through building active partnerships and collaboration with other teams in Health Networks, Operations, Health Services and Legal, while also partnering with external health care providers and vendors. With the overall goal of improving and maintaining services for our external provider stakeholders, your team will manage business processes to optimize the performance of Wellmark’s credentialing against aging goals and NCQA criteria. 

About You: Because this role is a leader of others, you will directly impact the success, growth, and development of team members by establishing goals and objectives, setting clear expectations, defining accountabilities, providing regular coaching, facilitating change, and providing an overall positive work environment. Being a role model in behaviors that demonstrate Wellmark’s core competencies is a must. In addition to a passion for developing others, our ideal candidate is skilled at change leadership; effectively managing change will be critical from establishing the business case for change, to operationalizing and communicating evolving business processes both internally and externally. Experience with Visual Cactus/Symplr highly preferred. Facets experience, along with credentialing and health networks knowledge, is a plus!  

Hybrid Position: This position will work a hybrid schedule of at least 3 days in a Wellmark office (Tuesday-Thursday), with Monday & Friday remote option. 

Required:

• Bachelor’s degree in areas such as health care administration, public administration, business, marketing, with some study towards health care administration or insurance, or direct and applicable work experience.
• 7+ years of relevant work experience including leadership skills typically gained through a combination of project or informal leadership that demonstrates knowledge of work processes, services, or leadership competencies. Ability to effectively coach and mentor others and lead teams through change.
• Demonstrated ability to effectively organize and guide teams of people in the achievement of goals, objectives, and desired results, using team and consensus building skills while demonstrating commitment to recognition of /development of individual team members.
• Demonstrated ability to communicate effectively and professionally, verbally and in writing, expressing complex concepts clearly and concisely to various levels of audiences.
• Process management knowledge, as well as experience leading multi-division projects. Knowledge of and experience in using formal industry process management tools and programs.
• Data analysis skills and experience, as well as knowledge of industry reporting tools (i.e., Business Objects, Crystal, etc.).
• Travel required up to 5%.

a. Lead team and oversee activities that support Wellmark’s provider credentialing, policies, procedures, work instructions, and program manuals that support credentialing and appeals functions.

b. Represent the department and corporation regarding issues pertaining to Wellmark’s provider credentialing to external audiences including health care providers, health systems, national health care organizations, Blue Cross Blue Shield Association, third party vendors, and other stakeholders.

c. Provide leadership and day-to-day management of financial and human resources, primarily focusing on employee coaching, development, performance improvement, coordination, and budgeting for the team’s specific functions/services. Support business objectives and produce results that are effective, accurate, timely, and on target to meet business and stakeholder needs.

d. Serve as a subject matter expert and resource for internal departments when complicated provider issues pertaining to provider credentialing and network status need to be escalated for resolution.

e. Lead activities that support the maintenance and analysis of Wellmark’s provider credentialing and network status data housed in department database and Wellmark’s systems. Outcomes may include supporting provider data management, data extracts and report generations, with a focus on production, for the Network Administration Team. Identify trends and make recommendations regarding production efficiencies and effectiveness. Develop and implement plans once identified.

f. Lead key department/division and interdepartmental/interdivisional projects through the effective use of process management tools and programs.

g. Sustain effective production levels for the team/department through effective staff motivation, workload distribution and management to meet stakeholder requirements including cycle times and accuracy defect levels.

h. Meet or exceed reporting standards for department activities and compare all results against performance standards, and state and national standards. Continually seek new sources for validation of ‘best in class’ processes and participate in BCBSA or other surveys that compare this information.

i. Maintain successful NCQA accreditation in accordance with all requirements and work collaboratively with Wellmark leaders and quality staff.

j. Understand Wellmark and other payers’ provider credentialing and manage/maintain this information in department databases and other systems to support accurate reporting and claims processing.

k. 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 [email protected]