Jobs at GuideWell

Provide specialized corporate governance legal counsel to the Board and committees; prepare and manage Board materials; develop governance policies; advise on director qualifications, executive compensation, D&O matters, transactions, and compliance; coordinate with external stakeholders; manage governance records; conduct legal research and prepare opinions and memoranda.

Provide enterprise-wide legal counsel on federal and state healthcare regulatory matters. Monitor and interpret laws and enforcement activity, advise business units on compliance and regulatory strategy, develop policies, conduct regulatory risk assessments, coordinate with outside counsel, support compliance program implementation, respond to regulator inquiries, and prepare regulatory analyses for leadership and the Board.

Perform concurrent medical reviews using InterQual and benefit criteria to determine appropriate level of care, coordinate discharge planning, identify care programs, liaise with facility case managers and providers, and facilitate transitions to home-based services to reduce readmissions.

Lead enterprise AI governance, risk management, and Responsible AI adoption. Oversee AI inventory, policy, risk lifecycle, regulatory compliance, vendor assessments, and integration of governance into business workflows. Partner with Legal, Compliance, Security, PMO, and business units to prioritize AI initiatives, report metrics and ROI, and advise executives and boards.

Manage renewals for groups of 50-499 employees by developing renewal strategies, coordinating marketing and enrollment materials, maintaining agent and client relationships, educating agents on products and sales processes, resolving issues, and supporting retention and implementation efforts. Requires frequent travel within South Florida and appropriate insurance licensure.

Lead research and listening for a specific audience: design and run primary research, integrate listening signals, synthesize quantitative and qualitative insights, and deliver timely, decision-oriented recommendations while coaching analysts and partnering with enterprise stakeholders.

Perform utilization management duties including pre-certification and concurrent review of admissions, medical record review for medical necessity, discharge planning, steering to in-network providers, evaluating cost-effectiveness of treatment plans, identifying alternative care plans, interpreting health plans, coordinating authorizations and referrals to care management resources.

Provide nursing case management for expectant mothers: assess health status, coordinate inpatient/outpatient care, develop and monitor care plans, authorize services per plan provisions, identify cost-effective treatment alternatives, collaborate with providers and employers, and report outcomes to control costs and improve maternal health.

Serve as the product SME and technical analyst, supporting product lifecycle from launch to management. Deliver analysis on enrollment, pricing, competitiveness, and performance; coordinate cross-functional decision memos and stakeholder communication; support vendor and sales training; drive retention, enrollment, network, and forecasting initiatives; and facilitate policy, procedure, and SLA execution with internal partners including Legal, Actuarial, Compliance, Pharmacy, and Service Care.

Design and administer comprehensive employee benefits using data and market benchmarking. Manage medical, dental, vision, retirement, FSA/HRA, COBRA, FMLA, and vendor relationships. Ensure regulatory compliance, run open enrollment and RFPs, reconcile plan billings, maintain eligibility feeds, lead projects and software rollouts, and educate employees on benefits.

Develop and execute integrated internal communications plans, craft leadership and employee messaging across channels, advise leaders and partners, manage projects and vendors, apply analytics and AI-assisted tools to measure impact, and support executive and crisis communications within a healthcare enterprise.

Process and adjudicate medical, dental, vision, and mental health claims using computerized claims systems. Perform claims research, investigate overpayments, negotiate settlements, resolve appeals, verify plan coverage and medical necessity, and maintain accurate records while meeting productivity and quality standards.

Manage an actuarial team and produce actuarial analyses for pricing, reserves, trend analytics, gross margin and financial reporting across ACA, Medicare, and Group lines. Participate in rotational assignments, represent actuarial in cross-functional workgroups, and support pricing, reporting, and analytic initiatives.

Serve as primary contact for assigned accounts resolving complex claims and escalated customer-service issues via inbound/outbound calls. Track and research appeals, locate network providers, collaborate with benefit consultants, train customer service staff, and support special projects.

Senior individual contributor leading enterprise value-based care strategy, defining value-based products and multi-year provider attribution targets. Translate market dynamics and provider performance into repeatable playbooks, coordinate with contracting and performance teams, pilot new models and engage large provider organizations to bring value-based offerings to market.

Provide administrative and operational support to leadership: prepare and validate data and reports, coordinate cross-functional communications, support projects, produce presentations, and perform executive support tasks to enable strategic focus and continuous improvement.

Senior leader responsible for enterprise acquisition marketing strategy and serving as CMX's strategic representative to the ACA segment. Leads acquisition planning, creative and communications, campaign operations, and local market/sales support. Mobilizes cross-functional CMX experts, oversees campaign execution across channels, ensures compliance, drives performance measurement and forecasting, and builds trusted relationships with segment leaders to align marketing to business growth targets.

Manage and grow relationships with mid-sized employer clients and distribution partners, ensure plan performance, lead cross-functional teams for implementations and renewals, drive retention and upsell, ensure compliance, and deliver exceptional client support and reporting.

Handle inbound provider and member calls to resolve complex client-related claims and benefit issues. Research appeals and benefits, locate network providers, collaborate with Benefits and Benefit Consultants, train client-dedicated customer service staff, track inquiries in systems, and support special projects.