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.

Serve as a technical resource to Claims Examiners in the resolution of claims issues and detailed inquiries. Provide technical support and guidance to team members. Successfully develop and maintain team member relationships through positive interactions. Research and coordinate with internal stakeholders to bring resolution to improve the customer experience. Responsible for quality and production reports, training team members, answering questions and monitoring unit progress.

The Claims department has three senior level opportunities. We are seeking self-motivated individuals skilled in mentoring and coaching others with a high aptitude to provide support in investigating and resolving complaints and detailed inquiries, and resolution to complex claims issues while providing guidance to team members. The three areas for support include:

Claims Inquiry Resolution

Regular Business Claims & Adjustments

Coordination of Benefits Claims & Adjustments

Required:

High School Diploma or GED

3+ years of relevant work experience including:

• Health insurance operations claims, customer service or membership and enrollment.
• Production oriented environment with quantity & quality goals.
• Ability to use deductive reasoning to probe, research, ask questions, seek to understand; weighs alternative actions and makes decisions that incorporate data, opinions and facts.
• Experience with coaching and mentoring others.
• Ability to perform, document and or guide others through a series of related steps; recommend and/or make changes to workflow to improve process.
• Demonstrated ability to effectively communicate verbally and in writing.
• Customer focused/driven and the ability to proactively develop positive relationships by listening, understanding, anticipating and providing solutions to customer needs.
• Ability to use mathematical techniques to calculate data or solve practice problems.
• Excellent organizational, prioritization and time management skills.
• Ability to enter data with accuracy and timeliness and proven efficiency in Microsoft Office Suites

Preferred:

• Experience with Coordination of Benefits is strongly preferred
• Experience with health care claims
• Informal Leadership

a. Serve as a technical resource to Claims Examiners in the resolution of claims issues and detailed inquiries. Apply advanced skills and knowledge to investigate and resolve complaints. Partner with internal stakeholders to resolve issues.

b. Provide technical support and guidance to team members. Successfully develop and maintain team member relationships through positive interactions.

c. Conduct side-by-side and group trainings as needed and effectively provide quality assurance feedback in a professional manner. Assess results and make recommendations for enhancements as needed.

d. Monitor/align and distribute work to team members and make adjustments as work flows fluctuate. Review workflows and processes, identify issues and opportunities, rewrite workflows, and partner with systems team to update workflows and processes.

e. Research and coordinate with internal stakeholders to bring resolution to improve the customer experience. Communicate and confirm resolution with the customers.

f. Provide claims support during peak activity levels and serve as a back-up when needed.

g. 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