What you'll do at

Position Summary...

What you'll do...

Do you have an inherent curiosity and drive to ask questions and understand things? We are seeking an individual with a strong analytical mindset to join our Health and Wellness Reconciliation team. Our team embodies Walmart's motto of "Save Money. Live Better." by ensuring that pharmacy benefit managers uphold their contractual pharmacy reconciliation obligations. We review contracts, input necessary reconciliation terms into our internal system, complete quarterly reconciliations, and help resolve any differences with the pharmacy benefit manager.

The successful candidate will have the opportunity to work with several teams such as Legal, Contracting, Payers, and Finance/Accounting. Familiarity with cross-functional platforms like Excel, Dataiku, and Big Query will be beneficial.

If you have a problem-solving approach and are eager to learn, we would love to hear from you!

Participates in medical fee hearings by

• consulting with the Legal department to identify legal issues
• serving as an expert witness and providing testimony regarding medical coding
• reviewing medical resources and summarizing facts
• completing standardized forms and attaching necessary documentation for fee petitions and disputes
• resending medical coding information
• offering recommendations to address issues, settlements, and reserve changes
• participating in depositions and mediations.

Researches complex bill review data to identify trends and implement best practices by

• running and analyzing reports
• determining root causes of increased charges or payment allowances
• determining solutions to negative trends
• maximizing benefits of positive trends (for example, applying cost savings across multiple states)
• evaluating performance metrics (for example, reconsideration logs, savings dashboard)
• partnering with other teams (for example, analytics, senior coordinators, case managers, medical providers, defense counsel, regulatory agencies)
• developing and maintaining workflow processes to ensure accurate implementation.

Ensures compliance with laws and regulations by

• researching changes to federal, state, and local laws and regulations impacting insurance payment of medical bills
• ensuring changes in state reporting requirements, periodic fee schedules, and applicable laws and regulations are applied to bill review process and procedures
• evaluating auditing results to ensure the audit forms measure the desired quality results
• modifying the auditing process as regulatory agency requirements change
• building and maintaining relationships with other bill processing teams, state agencies, the Legal department, and bill review suppliers to clarify regulations or implement systematic changes required for compliance
• evaluating vendor processors quality audit results, providing feedback on results to vendor processors, and creating action plans to correct deficiencies; and ensuring regulatory certifications for state and federal utilization and bill review are obtained.

Assists with vendor contracts by

• holding vendors accountable for delivering contracted services
• ensuring contract language meets business and compliance requirements
• monitoring workflow and changing it to meet vendor requirements to obtain discounted services
• ensuring claims team complies with contract requirements.

Demonstrates up-to-date expertise and applies this to the development, execution, and improvement of action plans by

• providing expert advice and guidance to others in the application of information and best practices
• supporting and aligning efforts to meet customer and business needs
• building commitment for perspectives and rationales.

Provides and supports the implementation of business solutions by

• building relationships and partnerships with key stakeholders
• identifying business needs
• determining and carrying out necessary processes and practices
• monitoring progress and results
• recognizing and capitalizing on improvement opportunities
• adapting to competing demands, organizational changes, and new responsibilities.

Models compliance with company policies and procedures and supports company mission, values, and standards of ethics and integrity by

• incorporating these into the development and implementation of business plans
• using the Open Door Policy
• demonstrating and assisting others with how to apply these in executing business processes and practices.

#LI-MF4

Live our Values

Culture Champion

• Models the Walmart values to foster our culture; holds oneself and others accountable; and supports Walmart's commitment to communities, social justice, corporate social responsibility, and sustainability; maintains and promotes the highest standards of integrity, ethics and compliance.

Servant Leadership

• Acts as an altruistic servant leader and is consistently humble, self-aware, honest, and transparent.

Embrace Change

Curiosity & Courage

• Demonstrates curiosity and a growth mindset; fosters an environment that supports learning, innovation, and intelligent risk-taking; and exhibits resilience in the face of setbacks.

Digital Transformation & Change

• Seeks and implements continuous improvements and encourages the team to leverage new digital tools and ways of working.

Deliver for the Customer

Customer Focus

• Delivers expected business results while putting the customer first and consistently applying an omni-merchant mindset and the EDLP and EDLC business models to all plans.

Strategic Thinking

• Adopts a holistic perspective that considers data, analytics, customer insights, and different parts of the business when making plans and shaping the team's strategy.

Focus on our Associates

Diversity, Equity & Inclusion

• Identifies, attracts, and retains diverse and inclusive team members; builds a high-performing team; embraces diversity in all its forms; and actively supports diversity goal programs.

Collaboration & Influence

• Builds strong and trusting relationships with team members and business partners; works collaboratively and cross-functionally to achieve objectives; and communicates with energy and positivity to motivate, influence, and inspire commitment and action.

Talent Management

• Creates a discipline and focus around developing talent, promotes an environment allowing everyone to bring their best selves to work, empowers associates and partners to act in the best interest of the customer and company, and regularly recognizes others' contributions and accomplishments.

At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more.

You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable.

For information about PTO, see https://one.walmart.com/notices .

Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates. Tuition, books, and fees are completely paid for by Walmart.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms.

For information about benefits and eligibility, see One.Walmart .

The annual salary range for this position is $70,000.00-$130,000.00

Additional compensation includes annual or quarterly performance bonuses.

Additional compensation for certain positions may also include:

- Stock

Minimum Qualifications...
Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.

Minimum Qualifications: Bachelor's degree in Business Management, Accounting, Project Management, Healthcare Management, or related field OR 2 years' experience in insurance claims, accounting, or related area.

Preferred Qualifications...
Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.

Masters: Business Administration

Primary Location...

2608 Se J St, Bentonville, AR 72712, United States of America

About Walmart

At Walmart, we help people save money so they can live better. This mission serves as the foundation for every decision we make, from responsible sourcing to sustainability-and everything in between. As a Walmart associate, you will play an integral role in shaping the future of retail, tech, merchandising, finance and hundreds of other industries-all while affecting the lives of millions of customers all over the world. Here, your work makes an impact every day. What are you waiting for?

Walmart, Inc. is an Equal Opportunity Employer- By Choice. We believe we are best equipped to help our associates, customers, and the communities we serve live better when we really know them. That means understanding, respecting, and valuing diversity- unique styles, experiences, identities, abilities, ideas and opinions- while being inclusive of all people.

Hello, NW Arkansas

With over 200 miles of trails, an emerging locally-sourced food scene, the world-renowned Crystal Bridges Museum-NWA has something for everyone.

---