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.

Help us lead change and transform Wellmark's business

The health care industry is changing, and Wellmark is working to help change it for the better. We recognize that our members deserve health care with a focus on quality. We also recognize that health care is complex. We’ve embarked on a journey to support our members to use and navigate the health care system in order to help them make clear, informed decisions, and we’re also ensuring that we take a team-centric approach when working with and in support of our members. The work that our diverse business and care teams are doing in collaboration with our health care partners will create these changes, all while working to minimize health care costs.

Use your strengths as a Claims Preparation and Entry Specialist II by providing high quality and timely claims triage services in the keying and preparing of moderate to complex claims during the entry function. You'll review claims and make decisions regarding claims based on how to properly route/enter them while ensuring accuracy and quality scores are being met.

This position is eligible to be fully remote after the successful completion of a 4-6 week onsite training.

Required:

High School Diploma or GED

Minimum 1 year experience including:

• Experience in health insurance related operations, such as claims, customer service and/or membership and enrollment
• Previous experience in a production environment; experience working in an environment with quantity and quality goals
• Data entry and organization skills
• Effective written and verbal communication skills
• Attention to detail and self-starter
• Ability to multitask and problem solve
• This role has an essential function of lifting or carrying up to 50lbs.

a. Responsible for the entry, investigation, triage and analysis of moderate to complex claims.

b. Researches errors on claims and provides complete resolution to allow the claim to be entered into the processing system appropriately. Will research and validate claims documentation by cross-referencing multiple claims systems to ensure accurate documentation.

c. Investigate, analyze and develop solutions for claims entry issues. Ensure claims are accurately entered into system(s).

d. Completes daily reporting of receipts, production, aging and inventories.

e. As needed will mentor/train new team members, including reviewing the work of new team members.

f. Effectively communicates using verbal and written skills with peers, internal and external customers.

g. As needed, will sort and route customer and provider claims or inquires, to the appropriate areas within and outside the company or prepare letter(s) to be sent to both members and providers.

h. 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