Payment Policy Analyst, Clinical (Licensed Practical Nurse or Registered Nurse)

Job overview

The Payment Policy Analyst, Clinical role is hybrid in Des Moines, IA, with at least three days in the office Tuesday through Thursday and remote work available Monday and Friday; compensation is not specified. Wellmark is a mutual insurance company serving policyholders across Iowa and South Dakota, and this role is part of its Payment Integrity team. The analyst reviews claims and clinical documentation to support accurate payment under established policies. The role researches complex issues, identifies trends and inconsistencies, and develops recommendations that help improve payment policies, claims processes, and benefit savings.

What you'll do

• Research, analyze, develop, maintain, coordinate, and document payment policies
• review provider payment claims and trends
• investigate complex claims and provider inquiries
• monitor healthcare trends and regulations
• collaborate with vendors, providers, Medical Directors, and internal stakeholders
• support system conversions and documentation.

What we're looking for

Skills & competencies

payment policy analyst

clinical

licensed practical nurse

registered nurse

claims review

payment integrity

hybrid

des moines ia

wellmark

coding certification

medical records

Work arrangement

• Weekend coverage required

Why this role

Requires an active, unrestricted Iowa or South Dakota LPN or RN license and a coding certification or ability to obtain one within six months. The role requires at least three office days each week in Des Moines.

About the employer

Wellmark, Inc. is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.