Job Closed
This listing is no longer active.
Health Services Clinical Configuration Analyst
Location
Iowa
Posted
63 days ago
Salary
0
Seniority
Senior
Job Description
Health Services Clinical Configuration Analyst
Wellmark Blue Cross and Blue Shield
• 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
Job Requirements
- Active and unrestricted Registered Nurse (RN) license in Iowa or South Dakota is preferred
- Ability to retrieve and analyze data using Excel and SQL
- Exposure to health services systems (e.g., Jiva) including system configuration
- Ability to coach and mentor others
- Bachelor’s degree in related field or direct and applicable work experience is required
- A minimum of 4 years of diverse experience in a health care, health insurance, or similar work environment is required
- Must have direct clinical care to the consumer experience, health and care management or related program experience
- Strong understanding of the health care industry
- At least 1 year of business and systems analysis experience is required
- Strong analytical skills and the ability to influence and lead others
- Must be able to understand complex processes and promote change
- Strong process improvement skills
- Strong written and verbal communication skills
- Proficient with Microsoft Office applications
Benefits
- Health Services Clinical Configuration Analyst is remote eligible
- Flexibility to work where you are most productive
- Ability to come into a Wellmark office periodically if desired
Related Guides
Related Categories
Related Job Pages
More Analyst Jobs
HubSpot Analyst – Business Intelligence (BI)
Nasajon SistemasSomos movidos a uma vontade incansável de inovar e potencializar empresas.💡
• Serve as the technical point of contact for HubSpot within the company • Create, configure, and manage complex workflows and automations • Design and build customized reports and dashboards to support decision-making • Perform data cleansing, organization, and maintenance of the CRM database • Map and structure business processes related to marketing, sales, and Customer Success (CS) • Collaborate with cross-functional teams to align operational workflows and implement process improvements • Ensure the integrity and reliability of data used by leadership • Validate and oversee external consultants related to HubSpot
Established in 1995 and rebranded to Scout in 2024, we built our foundation on planning meetings for numerous organizations within the life sciences sector (Scout Meetings). In response to emerging industry needs, we expanded our services to include Scout Clinical, one of the top providers of clinical trial patient reimbursements and travel. Scout is recognized as a leader in our field for innovation in service, attention to detail, our stellar team members, and making the complex easier. If this interests you, we’d love to have you join our rapidly growing team! Position Summary: The Proposal Analyst I ensures the accurate and timely creation of proposals for Scout’s services supporting clinical trials. This role collaborates with cross-functional teams including Business Development, Contracts, Project Management, and Compliance to deliver high-quality proposal estimates aligned with client requirements and internal standards. Responsibilities of this position include but are not limited to: - Develop proposal estimates for patient travel and reimbursement services under general supervision. - Adhere to Scout’s standards for proposal development, including presentation, accuracy of budgets, and clear documentation of assumptions. - Review client proposal requests to identify requirements and align deliverables with established templates and guidance. - Ensure proposals are accurately tracked within Scout databases. - Participate in internal and client-facing discussions to support proposal development. - Support team members through peer review as directed by management. - Complete all required initial and ongoing training within a reasonable or provided timeframe. The ideal candidate will have the following experience, skills, and knowledge: - Bachelor’s degree or equivalent experience - Experience in the clinical/healthcare industry preferred - Experience in proposal development preferred The ideal candidate will have the following competencies and qualities: - Strong attention to detail and ability to produce high-quality deliverables within deadlines - Excellent written and verbal communication skills. - Proficiency in Microsoft Word, Excel, Outlook, and SharePoint preferred. - Professional, courteous, and collaborative approach to communication. - Strong analytical and problem-solving abilities with demonstrated critical thinking skills. Scout offers a competitive compensation and benefits package that includes contributions to your HSA and 401k. Visit our website at www.scoutclinical.com or follow us on LinkedIn for other employment opportunities. WE ARE AN EQUAL OPPORTUNITY EMPLOYER
At Goldschmitt and Associates LLC (G&A), we’re not just another company—we’re a catalyst for innovation and impact, and we’re inviting passionate, forward-thinking individuals to join us on this journey. Recognized multiple times on the Inc 5000 list of the fastest-growing companies, G&A is a leader in tech transformation and system modernization for some of the nation’s most important federal agencies. Our culture is built on creativity and collaboration. We offer flexible schedules, telework options, and an environment where your ideas truly matter. At G&A, you won’t just clock in—you’ll be solving real-world challenges and working on projects that make a difference in the lives of millions. Joining our team means becoming part of a vibrant, connected community where innovation thrives, your voice is heard, and your impact is felt. Whether you’re a tech enthusiast, a strategic thinker, or a problem-solver, at G&A, you’ll have the opportunity to level up your career while making a real-world impact. If you’re ready to be part of a company that values purpose as much as progress, G&A is the place for you! Summary: Goldschmitt and Associates is seeking a Case Analyst I. The Case Analyst I shall provide a variety of professional duties necessary to accurately complete the review process with accurate and timely processing, adjudication, customer-oriented communication when required, and quality recommendations for all GCBD Certification cases. This includes all new tasks, recertifications, change requests, and document submissions. Normal duties are performed without direct supervision. Guidelines consist of SBA policies, procedures, directives, IGPM and applicable legislation. Duties are designed to relieve Government case analysts of a variety of technical and analytical duties. Job Duties and Responsibilities: - Working the entire application process for all GCBD cases to deliver a final recommendation of Approve, Withdraw, remove, decertify, change request, and denials. Final determinations other than withdraw are an inherently governmental task which will be made by SBA personnel. Follow all IGPM’s for these processes. - Analyzing and reviewing GCBD applications for relevance and quality to determine a recommended determination to SBA officials based upon the supplied and required documentation and available research for each case assigned. All recommendations must be supported and annotated in the web-based case management system. - Confirming and adequately documenting in the web-based application, the areas of deficiency in an application such that the Agency customer assistance or Federal Analyst can accurately provide a communication to applicants and representatives which will collect additional required documents, clarifying information, and resolve discrepancies. - Reviewing supplemental submissions by applicants to determine whether or not they are responsive to the deficiencies previously identified. - Preparing and analyzing information to determine program eligibility. This requires the ability to read and analyze business and financial documents, as well as web-based, external information sources, to determine whether an applicant’s request should be approved, declined, or referred for additional review. - Delivering a recommendation to the Agency within no more than 30 days of contractor time, i.e., Application is ready to approve, Application is ready for denial or decline, or the application is deficient (after two attempts by Case Analyst to allow GCBD applicant to resolve) and/or needs more information. Each recommendation and its justification must be clearly documented within the established case management system. - Explaining and/or writing in the case management system, in clear terms, any issue(s) that is (are) or are not in compliance with the applicable application prompts, regulation, or statutes; clearly connecting the program requirements with the applicability and sufficiency of the submission materials. Use the following methods to correct case issues as appropriate: - Use the deficiency process to allow applicants to fix any business document issues. To include complex case fact patterns. Allow the applicant to address issues in each case two times - Use the messaging system to clear issues that can be resolved with simple explanations versus asking for changes in documentation. - Use the withdrawal and or removal Functions as appropriate to complete case actions. - When a denial or decertification is required: complete the templated decline or decertification letter in the case management system to provide the Agency with a professional, signature-ready, concise document (or equivalent) that explains in clear terms the issue (s) that is (are) not in compliance with the applicable regulation or required statutes. Each letter must reference case fact patterns and tie them into specific regulations. Recommendations for possible denial fact patterns should demonstrate excellent understanding of applicable regulations and statutes. Minimum Qualifications: - Possess 2-3 years of experience in loan underwriting or equivalent analytical review work - Possess an Associate’s degree or higher - Possess the ability to obtain and maintain a Public Trust clearance NOTE: This job description is not intended to be an exhaustive list of all duties, responsibilities or qualifications associated with the job. It is intended to describe the general nature and work responsibilities of the position. This job description and the duties of this position are subject to change, modification and addition as deemed necessary by the Company. Goldschmitt and Associates offers the following benefits: - 401(k) with immediate vesting - Paid Federal Holidays - Tuition Reimbursement - Medical Insurance, including Vision and Dental Insurance - Employer-Paid Short-Term and Long-Term Disability - Employer Paid Life Insurance - Supplemental Life Insurance - FSA/HSA Programs - Commuter Benefits Program - Adoption Assistance Program - Employee Assistance Program (EAP) - Caregiver Support Program - Health Advocacy Program - Financial Wellbeing Support Goldschmitt and Associates is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.
• Develop and deliver executive-level financial presentations, Board of Directors reports, and standard monthly/quarterly close materials. • Ensure month-end close reconciliations are accurate and provide detailed variance analysis for key stakeholders. • Create clear and strategic narratives for financial performance insights. • Support the annual budgeting process, quarterly forecasts, and long-term strategic financial planning. • Collaborate with business unit finance teams to align financial plans with overall company objectives. • Support decision-making with thorough and well-documented financial insights. • Enhance management reporting and operational performance analysis. • Identify opportunities for financial and operational improvements across the organization. • Implement and maintain financial models and databases that align with evolving business needs. • Conduct rigorous analysis and ensure accuracy in projections, including scenario analysis and stress testing. • Produce detailed monthly, quarterly, and annual financial reports. • Perform budget variance analysis, KPI tracking, and strategic insights for leadership and Board presentations. • Regularly track and report KPI performance, ensuring alignment with company goals. • Identify and implement process improvements to enhance efficiency, reporting accuracy, and stakeholder value.



