Payment Policy Analyst - Clinical (LPN or RN required)

Use Your Strengths at Wellmark as a Payment Policy Analyst - Clinical! The Payment Policy Analyst plays a critical role within our Payment Integrity team, helping ensure provider claims are paid accurately, efficiently, and in accordance with payment policies. In this role, you’ll review provider payment inquiries, claims, medical records, and supporting documentation to identify trends, investigate inconsistencies, and understand not only what happened with a claim, but why. You’ll apply your knowledge of claims, coding, and medical terminology to research complex issues, develop well-supported recommendations, and translate detailed clinical information into clear, actionable insights. You’ll collaborate with Payment Integrity partners, Medical Directors, Medical Policy, and other stakeholders to enhance payment policies and processes. Ideal candidates are naturally curious, analytical, and detail-oriented problem solvers who enjoy digging into complex questions and looking beyond the first answer. You’re comfortable asking questions, challenging assumptions, and escalating concerns when appropriate, and you use credible sources to reach thoughtful conclusions. You’re highly collaborative, enjoy working as part of a team, and can adapt quickly as priorities, processes, and business needs evolve. You’re a lifelong learner and consistently aim to learn. Varied clinical experience is a must. Claims and/or coding knowledge will help you succeed, particularly when reviewing complex medical records and interpreting diagnosis codes, modifiers, and other claim information.  Hybrid environment: This position will work a hybrid schedule of at least 3 days (Tuesday, Wednesday, Thursday) in Wellmark's Des Moines office, with 2 days (Monday, Friday) remote option.