Provider Engagement Associate Consultant

About the role: 

As a Provider Engagement Associate Consultant you will support the development and maintenance of strong collaborative relationships with health care organizations participating in Wellmarks partnership with Provider Engagement leadership and Provider Engagement Consultants (PECs) you will increase provider engagement capacity and serve as the primary engagement and relationship owner for assigned provider segments. You will do this through operating within Wellmarks provider support model to deliver a differentiated engagement approach based on provider impact complexity and addition you will execute tier-based engagement strategies and own complex provider issues and engagement activities that require independent judgment crossfunctional coordination and proactive communication. You will act as an extension of the PEC team enabling PECs to focus on enterpriselevel strategy and priority initiatives while ensuring consistent highquality engagement across the broader provider population. Lastly you will operate with delegated authority to independently manage provider relationships resolve complex operational issues and deliver a differentiated engagement approach.

Qualifications :

Preferred Qualifications - Great to have:

• Experience working with claims processing and inquiry systems provider credentialing and contracting workflows or contact/engagement management systems.
• Experience in roles that emphasize relationship management strategic consultation or provider engagement including face to face interactions with health care organizations.
• Demonstrated ability to influence and consult with stakeholders at varying levels of an organization to support adoption of initiatives and resolution of complex issues.
• Experience analyzing qualitative and quantitative data (e.g. claims operational or quality data) to identify trends support decision making or inform provider engagement strategies.
• Experience supporting pilots programs or new initiative rollouts within a health care or health insurance environment.
• Ability to develop and maintain documentation of processes procedures and operational tools while following established guidelines.

Required Qualifications - Must have:

• Bachelors degree or direct and applicable work experience.
• Minimum of 3 years of progressive experience in a health care health insurance or related environment with experience in one or more of the following areas: provider relations reimbursement credentialing contracting claims payment medical policy customer or provider services or operational support roles.
• Demonstrated ability to build and maintain positive working relationships with external providers (e.g. physicians hospitals) and internal stakeholders across multiple departments.
• Strong verbal and written communication skills including the ability to clearly explain complex concepts and deliver presentations to both small and large audiences internally and externally.
• Demonstrated subject matter expertise or working knowledge of provider facing systems and processes including the ability to analyze inquiries determine appropriate resolution paths and coordinate with subject matter experts.
• Strong analytical problem solving workflow and critical thinking skills with the ability to manage multiple priorities and projects in a fast paced environment.
• Ability to operate independently while collaborating effectively within cross functional teams to support shared goals and timelines.
• Proficiency with Microsoft Office applications including Word Excel Outlook and PowerPoint.
• Strong organizational time management and prioritization skills with the ability to adjust to changing business needs.

Additional Information :

What you will do:

a. Serve as the accountable relationship and operational owner for complex provider issues within assigned provider segments determining resolution strategy cross functional stakeholder engagement and escalation thresholds.

b. Maintain positive collaborative relationships between Wellmark and in network providers that do not have an assigned Provider Engagement Consultantprimarily smaller/non strategic providers serving as a primary engagement contact and routing strategic/complex needs to PECs or leadership per guidelines.

c. Increase provider engagement and satisfaction through consistent proactive communication outreach (education reminders updates) and timely issue resolution including leading virtual meetings as appropriate to address complex or escalated provider concerns.

d. Act as an extension of the Provider Engagement Consultant team by supporting relationship management activities follow ups and provider engagement efforts.

f. Provide subject matter expertise on provider facing systems and operational processes which may include credentialing claims utilization management and medical policies to support effective inquiry and escalation resolution.

g. Document triage track and manage provider escalations through the Network CRM or related engagement systems ensuring accurate documentation follow through and data integrity. Adhere to CRM documentation standards for assigned segments; validate case taxonomy trend tagging and closure codes to enable reliable reporting and insight.

h. Analyze provider escalations consult with appropriate subject matter experts determine recommended resolutions and clearly communicate outcomes to providers and internal partners.

i. Proactively educate providers during engagement and issue resolution to promote self service tools and resources (e.g. Check a Claim Tool Authorization Table Provider Guides) track uptake where feasible and reduce repeat inquiries to improve the provider experience. Partner with provider communications owners to inform segmentation targeting and content needs for assigned provider audiences; provide field intelligence and validate clarity/actionability.

j. Monitor and analyze trends in escalated inquiries provider training needs and recurring pain points; document themes and coordinate closed loop follow up with internal stakeholders to inform improvements. Create and maintain recurring segment insight summaries (e.g. top drivers of friction repeat inquiry drivers self-service adoption barriers) and translate into prioritized improvement recommendations for internal partners.

k. Provide high level operational and engagement support for Provider Engagement initiatives pilots programs and new provider facing rollouts including supporting provider communications webinars or job aids to promote change readiness.

l. Participate in and deliver provider and internal education sessions as assigned by leadership.

m. Accountable for measurable outcomes within assigned provider segments including provider experience escalation volume timeliness of issue resolution reduction in repeat inquiries and adoption of self-service tools.

n. Other duties as assigned.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit hire train and promote individuals in all job classifications without regard to race color religion sex national origin age veteran status disability sexual orientation gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at

Please inform us if you meet the definition of a Covered DoD official.

At this time Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States. This includes but IS NOT LIMITED TO: F1-OPT F1-CPT H-1B TN L-1 J-1 etc. For additional information around work authorization needs please refer to the following resources:Nonimmigrant Workers and Green Card for Employment-Based Immigrants 

Wellmark supports and expects the responsible use of AI for our workforce! We welcome the responsible use of these tools by job seekers as well and are interested in learning from you; you will have an opportunity in the application process to share which tools you used and how you applied them. 

Remote Work :

No

Employment Type :

Full-time