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GuideWell Mutual

Nonprofit mutual health insurance group in Florida

Business EDI Operations

Business OperationsConfirmed live in the last 24 hours
Full-timeIrving, TX, USANo salary listed

About the Job

Requirements

  • At least 4 years of related work experience.
  • Prior experience working closely with 835 EDI files.
  • A bachelor's degree in Business Administration or a related degree is required; additional related equivalent work experience may substitute.
  • Advanced reporting skills and significant experience working in Microsoft Word, Excel, and PowerPoint.
  • Ability to multitask, prioritize responsibilities, and take initiative with current projects.
  • Demonstrated flexibility with changing responsibilities.
  • Proactive in asking questions, seeking clarification, and navigating ambiguity.
  • Strong oral and written presentation and communication skills.
  • Ability to work across organizational operational areas with key decision-makers and leadership.
  • Ability to work in ambiguity and present information in a way others can understand.

Responsibilities

  • Provide analysis and reporting to support projects, including EDI 835 file maintenance and accuracy, with a primary focus on continuous improvement to meet client needs and demands.
  • Update processes and procedures and perform administrative tasks.
  • Assist with clinical implementation as requested by leadership.
  • Support training initiatives and tasks as needed.
  • Assess situations quickly and create short-term solutions with long-term improvement plans based on input from others and findings from data analysis.
  • Address escalations by identifying root causes and analyzing day-to-day operations within Communitas.
  • Generate reports and data to identify trends and strategically partner with department leaders on current triggers, including processes, procedures, and impact.
  • Enable growth and capabilities by streamlining processes and systems.
  • Participate in calls and meetings with clients and leadership as requested, and serve as a subject matter expert reading and reporting data to support necessary decisions.

Desired Qualifications

  • A master's degree is preferred.

About the Company

GuideWell Mutual

Nonprofit mutual health insurance group in Florida

GuideWell Mutual Holding Corporation is the not-for-profit, policyholder-owned parent of Florida Blue, the Blue Cross and Blue Shield health insurer for Florida. Its family of companies also includes Triple-S, which runs the Blue plans in Puerto Rico, and GuideWell Source, which processes Medicare claims for the federal government through Novitas Solutions and First Coast Service Options. Most income comes from health plan premiums paid by employers, individuals and Medicare members, plus fees for running claims for others. As a mutual, it has no shareholders, and Florida Blue policyholders control it. GuideWell was formed in 2013 and is based in Jacksonville, Florida.

Company size
10,001+
Company stage
Not listed
Total funding
Not listed
Headquarters
Jacksonville, FL
Founded
2011

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