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EDI Business Analyst - Operations

Location
Des Moines, Iowa
Job Type
Permanent
Posted
22 Sep 2022
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!

More about our unique benefit offerings here.

More about working at Wellmark here.

Job Description

Responsible for supporting the management of the electronic file processes for Wellmark groups and high-profile accounts. Assist as a subject matter expert to both internal and external customers on electronic file related issues. Support low to moderate complex group implementations and renewals including the analysis of upstream and downstream stakeholder impacts. Establish and maintain collaborative relationships with Technology, group administrators, vendors, and other stakeholders to improve and arrive at a positive member experience supporting Wellmark's strategies.

Qualifications

Required:
  • Bachelor's degree in science, business, accounting or related field or equivalent experience.
  • 2+ years of related experience including:
  • Experience with electronic enrollment systems and processes.
  • Experience working with rules-based client/server applications.
  • Experience working with mainframe technology and web-based applications.
  • Experience working in Microsoft Access.
  • Demonstrated knowledge of Microsoft Excel.
  • Ability to identify issues or inconsistencies; obtains relevant information, relates and compares data from different sources and identifies alternative solutions.
  • Analytical problem-solving skills and attention to detail; ability to identify and approach complex problems from different angles and apply technical knowledge to policies/procedures
  • Ability to communicate effectively verbally and in writing, expressing complex concepts clearly and concisely.
  • Ability to work under pressure to meet timelines and accuracy guidelines; flexible and adaptable to change.
  • Ability to work independently and cooperatively on teams, maintaining positive relationships with customers.
  • Capable of prioritizing work with little supervision.
  • Understanding of health insurance concepts.

Additional Information

a. Support the management of daily/weekly/monthly electronic file processes and data by analyzing, collaborating, and recommending changes to stakeholders including Wellmark high profile accounts. When applicable, obtain electronic data in a format useable within Wellmark systems for new implementations, renewals, and existing group vendor changes. Monitor and investigate errors resulting from electronic files.

b. Communicate and collaborate in a timely manner, with all stakeholders pertaining to electronic files for training, system changes/impacts, regulatory changes and implementations as well as to confirm desk-level procedures and process/system documents are created/updated.

c. Assist as a subject matter expert or lead point of contact for technology, vendors, groups and other stakeholders regarding customer impacts stemming from application, system, or file process disruptions.

d. Collaborate and work with stakeholders, vendors and other external entities for file functionality and integrations in compliance with Health Insurance Portability and Accountability Act (HIPAA), proprietary formats, implementation guide, Blue Cross and Blue Shield Association (BCBSA), and Federal Employee Program (FEP).

e. Analyze and troubleshoot file issues of low to moderate complexity. Leverage technical and business knowledge to understand issue and impact to business in order to create incident tickets and perform testing once system, application, or file has been fixed.

f. Provide review and consultation associated with pre and post implementation initiatives across market segments, applications, and processes to ensure the timely delivery of outcomes through business requirements and the execution of test cases.

g. Use a variety of techniques to ensure file processes and downstream systems are being validated according to the testing plan. Write and execute test cases, document traceability and findings, and ensure accurate and timely outcomes. Coordinate testing efforts and reporting of results to leadership and other stakeholders as needed. Collaborate with system integration testing resources to continually update and develop testing best practices.

h. Actively and consistently provide coaching, mentoring, and sharing of knowledge to team members factoring in different learning styles and skillsets.

i. When applicable, monitor the performance of third party vendors against service level (SLA) agreement requirements, review and confirm the accuracy of third party vendor invoices for payment, lead conference calls with vendor(s) to review SLA performance and ensure performance credits are received on monthly invoices.

j. Ensure accurate tracking of all hours in reporting system(s) for all work efforts.

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
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Details

  • Job Reference: 718905145-2
  • Date Posted: 22 September 2022
  • Recruiter: Wellmark, Inc.
  • Location: Des Moines, Iowa
  • Salary: On Application
  • Sector: Banking & Financial Services
  • Job Type: Permanent