Wellmark Blue Cross and Blue Shield

• Support Medical Policy Team’s operations • Create and manage monthly Medical Policy production timelines • Maintain Medical Policy material distribution lists • Verify that the monthly authorization table updates align with quality expectations • Support virtual Medical Policy Committee (MPC) operations • Partner with the coding specialist role in support of the Medical Policy Implementation Committee (MPIT) • Support Medical Policy leadership in initial research on impact of changes in vendor and BCBSA Reference Medical Policy changes • Monitor and triage Medical Policy inbox for external inquiries • Perform monthly medical policy coding analyses and SAP BusinessObjects reports • Ensure that all documentation related to health policy decisions is complete and accurate • Update system configurations for accurate administration of health policies • Participate in cross-functional meetings or initiatives to support the enterprise strategic priorities

• Support Medical Policy Team’s operations, including managing Medical Policy timelines • Verify that monthly authorization table updates align with quality expectations • Participate in cross-functional meetings to support enterprise strategic priorities • Perform monthly medical policy coding analyses and SAP BusinessObjects reports • Ensure documentation related to health policy decisions is complete and timely

• Support Medical Policy Team’s operations, including creating and managing monthly Medical Policy production timelines, quarterly production timeline for N/R/D Code processing, maintaining Medical Policy material distribution lists, and filing external appeals. • Verify that the monthly authorization table updates align with quality expectations and track performance metrics. • Support virtual monthly Medical Policy Committee (MPC) operations, including taking minutes, developing, circulating, and presenting agenda PowerPoint during monthly MPC virtual meetings. • Partner with the coding specialist role in the support of the Medical Policy Implementation Committee (MPIT). • Support Medical Policy leadership in initial research on impact of changes in vendor and BCBSA Reference Medical Policy changes and opportunities for new policy development. • Perform monthly medical policy coding analyses and SAP BusinessObjects reports to identify and recommend necessary changes based on comparison to BCBSA reference medical policies, sentinel commercial health plan benchmarks and utilization patterns and implementation of claim system edits to support its intent.

• Provide clinical leadership and subject-matter expertise for complex medical policy content • Ensure accurate implementation of medical policies and authorization requirements • Research and analyze system and business issues • Develop high-level requirements, test and implement solutions, and audit outcomes • Mentor and train Coding Specialists and provide policy-related training to operational partners • Maintain the claims processing system infrastructure to ensure compliance • Collaborate with teams to resolve coding-related denials and questions

• Provide clinical leadership and subject-matter expertise to support the analysis, configuration, and administration of complex medical policy content within claims processing systems, including Plan General Exclusion (PGE) rules and FACETS table maintenance. • Ensure the accurate implementation of medical policies, review criteria, and authorization requirements, while maintaining the integrity of system infrastructure and serving as a key liaison between business and technical teams. • Research and analyze system and business issues, develop high-level requirements, test and implement solutions, and audit and document outcomes. • Mentor and train Coding Specialists, and provide policy-related training and support to operational partners such as customer and provider services.

• Wellmark Inc. seeks a Sr Software Engineer – Dynamics CRM • Design, develop, test, implement, maintain, and document highly complex Microsoft Dynamics 365 solutions • Ensure completed activities meet project specifications, requirements and Wellmark standards • Lead discussions with Technology and business units on solution design and implementation • Collaborate with other areas of Technology to ensure solutions improve the user experience • Work to resolve technical problems for on-premise, cloud native, and hybrid applications • Serve as subject matter expert in the implementation of innovative, cost-effective business solutions for multiple applications.

• Lead full stack development for the Digital Services team, performing detailed systems analysis and implementation of high performing software solutions that are efficient and cost effective, supporting Wellmark’s business and Technology applications • Lead system development and guides the team in the design, development, code testing and debugging necessary to ensure successful completion or resolution of issues while focusing on utilization of emerging technologies • Orchestrate cross-functional end-to-end execution across diverse platforms, all meticulously aligned with Wellmark's SDLC standards and the structured SAFe methodology in order to culminate the making of these advancements accessible and beneficial to all Information Product teams and foster a unified and elevated approach to development and delivery • Work closely with UX/UI designers, product managers, Architects and DevOps engineers to create responsive, interactive, and high performing applications by delivering high quality code that ensures a seamless user experience across multiple devices • Develop and optimize web pages for maximum speed, accessibility and scalability • Develop and optimize backend architecture ensuring scalability, performance and security • Write clean, maintainable and efficient code, adhering to best practices and Wellmark engineering standards • Ensure mobile responsiveness of applications • Ensure analysis of defects to find root cause and guide others in the identification of potential improvement opportunities • Provide production support of applications including root cause analysis and break-fix resolution • Use data and cost measures (AWS, infrastructure, labor, etc.) to influence timely decisions, build consensus, and take actions to successfully deliver project or production support objectives and support benefits realization • Identify known issues, impacts to project or production outcomes if not resolved and escalate as necessary • Contribute to a collaborative agile environment, including PI Planning, iteration planning, estimation, demos and retrospectives

• Join Wellmark’s Health Services Business Support team in a consultative, clinically driven role • Apply deep clinical and care management knowledge to analyze and improve UM business workflows • Validate Health Services programs against business requirements and acceptance criteria • Partner with medical directors and cross‑functional teams • Review and evolve InterQual and custom clinical criteria • Ensure Wellmark’s medical policy is translated into UM systems • Evaluate and validate Health Services program activities against business requirements • Analyze Health Services processes and foster ideation of new or enhancements to existing business processes • Build and maintain constructive, interactive relationships with stakeholders and vendors

• Provide clinical leadership and subject-matter expertise to support the analysis, configuration, and administration of complex medical policy content within claims processing systems, including Plan General Exclusion (PGE) rules and FACETS table maintenance. • Ensure the accurate implementation of medical policies, review criteria, and authorization requirements, while maintaining the integrity of system infrastructure and serving as a key liaison between business and technical teams. • Research and analyze system and business issues, develop high-level requirements, test and implement solutions, and audit and document outcomes. • Serve as an expert resource for medical policy configuration and PGE coding, mentoring and training Coding Specialists, and providing policy-related training and support to operational partners such as customer and provider services. • Maintain coding integrity by monitoring utilization trends to identify and resolve system configuration issues. • Mentor and train Coding Specialist as well as provide specific topic training related to medical policy administration/PGE rules to other operational areas such as customer and provider service as needed.

• Provide clinical leadership and subject-matter expertise to support the analysis, configuration, and administration of complex medical policy content within claims processing systems, including Plan General Exclusion (PGE) rules and FACETS table maintenance. • Ensure the accurate implementation of medical policies, review criteria, and authorization requirements, while maintaining the integrity of system infrastructure. • Serve as a key liaison between business and technical teams. • Research and analyze system and business issues, develop high-level requirements, test and implement solutions, and audit and document outcomes. • Serve as an expert resource for medical policy configuration and PGE coding, mentoring and training Coding Specialists, and providing policy-related training and support to operational partners such as customer and provider services. • Must be willing to work core business hours of 8 AM - 5 PM Central Time.