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GuideWell Mutual

Nonprofit mutual health insurance group in Florida

Business Specialist - Business Project Management

Regulatory Compliance & EthicsPosted on Nov 9
Full-timeUnited States

About the Job

Requirements

  • At least 5 years of related work experience.
  • A related Bachelor's degree or additional related equivalent work experience.

Responsibilities

  • Serve as a liaison between internal clients and functional departments, helping clients achieve objectives by interpreting and applying internal and external laws, regulations, policies, procedures, standards and practices.
  • Identify risks, evaluate controls, and prepare findings and recommendations; implement compliance programs to prevent illegal, unethical, or improper business practices.
  • Conduct audits to ensure organizational programs are consistently administered in compliance with organizational policies and procedures, contractual obligations, rulings, laws, and government regulations.
  • Monitor and evaluate the effectiveness of solutions, policies, practices, and processes to support continuous improvement, good client relations, and adherence to business requirements; recommend improvements to deliver high-quality, value-added services.
  • Develop, implement, administer, and revise policies, procedures, and programs that meet business needs; assist with or lead program development and enhancements.
  • Research, analyze, maintain, modify, validate, and prepare data, information, and content used in business decisions; present findings and articulate results.
  • Produce, edit, and distribute business documents, including reports, proposals, policies, procedures, audit results, issue papers, marketing materials, newsletters, and brochures.
  • Create, present, and facilitate meetings, webinars, conference calls, training programs, education sessions, and certifications for internal and external audiences.
  • Represent the assigned function at external hearings, mediations, audits, and meetings.
  • Participate in or lead large, complex departmental or divisional projects; plan, organize, monitor, and control projects to ensure effective resource use and compliance with project management standards and reporting requirements.
  • Participate in Company workgroups and initiatives.
  • Develop and build internal and external partnerships to improve communication, coordination, collaboration, and working relationships within the department, across the Company, and externally.
  • Mentor and coach less experienced coworkers on technical and interpersonal skills needed for effective job performance.

Desired Qualifications

  • Demonstrated experience using artificial intelligence solutions to analyze large, complex datasets, including financial data, and translate findings into actionable insights.
  • Demonstrated experience using artificial intelligence solutions to establish and manage project plans, timelines, and deliverables for multifaceted initiatives.
  • Demonstrated experience performing financial analysis, including budgeting, forecasting, and variance reporting, to support strategic planning and decision-making.

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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