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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Use Your Strengths at Wellmark as a Credentialing Manager!  

In this critical role, you will support Wellmark’s delegated credentialing ecosystem and Network Administration’s Network Risk Management Program. This includes coordinating and facilitating the provider credentialing process when criteria are not met and/or are in question. You will build strong relationships with delegated entities to drive positive provider experience and administrative efficiencies and support change initiatives for any interactions between delegated entities and Wellmark.

Joining our team means taking ownership of high-impact projects, collaborating with stakeholders, and shaping compliance frameworks that uphold state and federal guidelines. Your expertise will help streamline credentialing operations, empowering us to deliver exceptional service in a dynamic healthcare environment. 

The ideal candidate applies an inquisitive and analytical mindset in their work, is proactive in identifying opportunities for improvement, and excels in problem-solving and detail-oriented decision-making. With a solid foundation in provider credentialing, risk management, and industry regulations, you will bring exceptional communication and facilitation skills to the forefront. Your ability to prioritize and manage complex projects will enable you to optimize enrollment processes, address compliance challenges, and immediately contribute to Wellmark’s operational excellence and efficiency. 

Preferred:

• Experience in Operations Business Support.
• Experience configuring Facets.
• Experience identifying processes for automation opportunities or implementing automation.
• Experience with claims remediation.

Required:

• Associate degree in science, business, accounting or related field or equivalent experience. 
• 5+ years of work experience in Health Insurance (carrier or at a Provider) including experience implementing initiatives.
• Excellent analytical, diagnostic problem-solving skills. Strong attention to detail and the ability to identify, research, and analyze issues, organize information, and make appropriate decisions by pulling reports, and interpreting and analyzing data.
• Excellent written and verbal communication skills with the ability to clearly and concisely communicate and/or present complex information to internal/external stakeholders; strong presentation and facilitation skills.
• Proactive self-starter with effective time management skills and the ability to organize and prioritize projects or tasks with little supervision. Ability to adjust to changing priorities and business needs.
• Ability to operate independently yet cooperatively on teams to appropriately manage priorities.
• Ability to understand end to end processes, impact of change on those processes, and to communicate that impact effectively.
• Demonstrated ability to build strong relationships.
• Demonstrated experience in process improvement.

a. Serve as a resource for Delegated Credentialing Entities for provider credentialing, re-credentialing, and change requests on behalf of Wellmark, Inc., preparing and communicating regularly on policy updates, revisions and general program and import file requirements. Provide education to others on electronic transfer processes.

b. Engage in the external provider credentialing and peer review process, and support the Credentialing Manager by preparing materials and facilitating meetings with providers. 

c. Build and maintain strong relationships with both delegates and internal Wellmark business partners. Communicate in a timely manner with Delegated Credentialing Entities, Credentialing Manager and Network Administration leadership about electronic loading error results and recommend file and/or system changes to reduce errors. As needed, provide updates regarding errors, changes, etc.

d. Support change initiatives for people, process, or system changes between Wellmark and delegated entities by providing proactive education to delegates and responding to requests for deliverables or information.

e. Partner with Credentialing Manager and Network Administration leadership to execute and maintain the provider data loading process electronically and monitor the delegates related to current Wellmark policies, file formats and procedures, and NCQA requirements.

f. Perform risk management and ongoing monitoring and take appropriate action as needed. 

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

h. Identify continuous improvement opportunities across Network Administration and drive team level continuous improvement initiatives.  

i. Process denials and termination as needed and according to established procedures and applicable state and federal laws (i.e. National Practitioner Data Bank/NPDB).

j. Participate in provider appeal processes, providing documentation and responding to questions from the panel. Participate in meetings and/or project requirements regarding changes to provider credentialing. Represent department on various other teams and projects. Ensure adherence and compliance with any contractual, regulatory obligations, and other applicable accreditation requirements.

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]

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