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Wellmark - Des Moines Team Leader - Special Inquiries in Des Moines, Iowa

Use your strengths as a Team Leader Special Inquiries at Wellmark!

In this role, you will lead, plan, and manage the day-to-day operations of the Special Inquiries team. You will oversee the review, research, and response to special inquiries and formal written post-service appeals, including complaints referred by the state insurance division, legislators, attorneys, and Wellmark stakeholders. You will be responsible for monitoring trends and escalating potential systemic issues for resolution as appropriate.

As a leader of others, you will directly impact the success, growth, and development of team members by setting clear expectations, coaching to each team member’s strengths, and fostering a team-centric work environment. Being a role model in behaviors that demonstrate Wellmark’s Leader Success Expectations and inclusion are essential. In addition, ideal candidates are also highly adaptable, capable of consistent reprioritization (every day brings a new challenge!), and are skilled researchers. They are trusted for their expertise and appreciated for their collaborative approach in delivering results.

**Work from home order: The effects of COVID-19 have moved our employees to a work from home environment. This role will start out fully remote but will be expected to work from the office upon our return. The time in which we expect to return to our office is undetermined but will take place when it is safe to do so.

Required:

  • Bachelor’s Degree or direct and applicable work experience

  • Minimum 4 years of experience in the following:

  • An appeals role, serving as a subject matter resource for researching and providing a written response to member appeals

  • The health insurance industry, with the ability understand the customer and meeting their needs

  • Proficient communication skills, both verbal and written, with the capability to gather data and develop and effectively communicate solutions to all levels of the organization

  • Effective critical thinking skills utilizing business knowledge to understand complex information and develop recommendations

  • Proven ability of information leadership skills typically gained by leading work teams, coaching, mentoring and facilitating work activities

  • Understanding of change management philosophies

  • Demonstrated experience using Microsoft Office including the use of spreadsheets and presentation and word processing software

  • Ability to measure and evaluate work processes to ensure the best methods and technology are implemented to meet the business needs

a. Provide leadership and day-to-day management of financial and human resources, primarily focusing on employee coaching,development, performance improvement, coordination and budgeting for staff and team specific functions/services. Support business objectives and produce results that are effective, accurate, timely, and on target to meet business and stakeholder needs.

b. Lead the ongoing operations of departmental functions to ensure compliance with internal standards, policies/procedures and external regulations. Participate in internal and external audits of complaint/appeal process.

c. Ensure that Special Inquiries meet the time frames established under ERISA. Ensure that appeals and responses to the Iowa Insurance Division on complaints are handled within the time frames established by regulation.

d. Compile and submit regulatory and accreditation reporting related to the complaint/appeal process on a timely basis.

e. Successfully achieve unit quality, production, and customer goals.

f. Research and resolve complex business problems and situations to the satisfaction of the customer.

g. Evaluate and initiate continuous process improvement, resulting in the reduction of rework and increased customer satisfaction. Lead and participate in cross functional project teams to successful outcomes.

h. Other duties as assigned.

Posting Title: Team Leader - Special Inquiries

Requisition ID: 214732

REQUIRES NON-COMPETE?: No

External Company Name: Wellmark Blue Cross and Blue Shield

External Company URL: www.wellmark.com

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