GuideWell Source

Product Manager

• Plan and oversee large scale transformation initiatives; including the definition, design, development, implementation, and integration of people, processes, and technology that lead to measurable outcomes.
• Serve as the lead, partnering closely with Executive Sponsor(s), Business Lead, segment leadership, and IT partners through key initiatives(s); serve as thought leader to solving business problems.
• Lead metric definition to translate expectations into KPIs and operational metrics.
• Lead cost/benefit assessment to define potential financial, business, and industry impacts of initiatives.
• Manage risk by establishing project management processes (regular status reports, etc.) to address execution challenges.
• Provide regular updates to leadership on accomplishments of key milestones, as well as risks or concerns.
• Mentor junior team members.

IT Product Manager

Medical Director

• Perform all types of utilization management (UM) reviews, including but not limited to Pre-service, Post-service, Concurrent Review and Appeals
• Discuss cases with physician providers (Peer to Peer)
• Apply health plan review hierarchy to member contracts, medical policy, clinical guidelines and other approved resources to render timely decisions on medical necessity requests
• Collaborate with Case Managers to provide support and guidance on cases needing physician assistance
• Meet any established metrics (compliance and accreditation) related to UM review efficiency, timeliness, and quality of review
• Participate in ongoing Inter-rater reliability (IRR) audits and any other health plan audits as necessary
• As necessary, assist nurses and other staff in understanding the principles behind appropriate utilization review and interpretation and application of benefits and policies
• Participate in the development and review of Medical and Pharmacy policies as assigned
• Support the organization as a subject matter expert
• Perform as lead Medical Director consultant for one sub-category of utilization management, such as commercial or Medicare medical policy
• Perform other duties as assigned and needed by the organization

Medical Director – Care Management

Database Administrator

• IT Database Administrator is responsible for administration of database platforms including monitoring, installation, configuration, debugging, administration, backup, recovery, troubleshooting, SQL tuning, and maintenance of database technologies.
• IT database administrator is responsible for database design, deploying database objects and ensuring data integrity is maintained and secured.
• IT Database administrator is also responsible to design and build high availability solutions to ensure stable and efficient operation of database technology solutions
• Performs installation, monitoring, testing, configuration, migration, maintenance, tuning, and troubleshooting of assigned database technology, as well as designing database deployments for high availability. Ensure database versions are current and deploys patches as required. Also assists with determining migration and upgrade impacts and diagnosing/resolving technology/application errors.
• Develop and implement controls required by CMS and other mandates/audit requirements.
• Automate database functions by programming/scripting as required. Assists with researching, designing, implementing, and testing of database technology solutions, and work with users and IT partners to understand requirements for a physical database design.
• Participate in Disaster Recovery planning and exercises. Proactively monitors and reports performance and utilization and adjust database configuration as appropriate.
• Resolves database alerts and performs remediation activities, manages problem or escalated tickets and tasks and out of cycle requests from systems/application owners. Provides input into processes and procedures related to database administration.
• Collaborates with IT and business area partners on work groups and initiatives. Performs On-Call activities as needed for the environment and database technologies

IT Database Administrator

Account Manager

• Develop and maintain strong relationships with aligned agencies and groups, and their business partners.
• Educate agencies on our sales processes, products, policies, and procedures.
• Communicate state and federal legislation impacts and assist agencies with implementing procedures.
• Act as a liaison between agencies, internal and external business partners, and Florida Blue.
• Manage resolution of escalated/complex issues and develop tactical plans to meet group needs.
• Support and coordinate retention processes, including periodic account meetings and analytical data reports.

Market Relations Manager

Counselor

• Own the College Counseling and Graduate Admissions Businesses & Drive Strategy
• Collaborate with business unit leaders and the President to co-author the annual budget
• Build the Operating System and standardized processes for sales and service delivery
• Lead a 100+ person division and act as the chief culture officer

VP, General Manager – Admissions & Counseling Division

Manager

• Lead the design, plan and strategy for employee engagement, volunteering and donations for GuideWell Enterprise (all business subsidiaries) in support of the company's mission and CSR strategy for the approximately 18,000 GuideWell associates across the country and Puerto Rico.
• Lead coordination of engagement strategies across each business unit, working with leadership to implement Enterprise strategy and programs.
• Lead the planning, implementation and activation of community engagement initiatives to support the Foundation and Enterprise strategy, working with community leaders to identify unmet needs, co-develop solutions and craft programs that create the desired impact.
• Develop, manage and evaluate strategic employee volunteer engagement plan to engage the Enterprise workforce and increase organizational effectiveness.
• Manage the GuideWell Gives employee volunteer program and oversee execution of all aspects of planning in collaboration with key geographical markets including communication, internal resource coordination and reporting.
• Maintain and manage the GuideWell Gives volunteer portal including administration, user support, reporting and analytics, and ensuring seamless integrations with GuideWell’s volunteer program goals and objectives.
• Strengthen connections with the local nonprofit community.
• Consult and coordinate with the GuideWell Community organizations to advise and support their community relations efforts.
• Raise awareness around GuideWell’s involvement in the community through coordination with Enterprise Communications; Communicate impact of community volunteerism and coordinate with Enterprise Communications.
• Work with the CEO and senior leadership in the coordination and implementation of events where they are heavily involved.
• Provide event and administrative support when executives lead external community engagement and outreach efforts.
• Work with GuideWell leaders and ambassadors, from all business areas and companies, to coordinate, plan, promote, and reconcile the annual GuideWell employee giving campaign, volunteer efforts, and other employee engagement initiatives.
• Develop and implement community engagement/board training for GuideWell leaders and teams.
• Develop and lead new Enterprise-wide skills-based volunteer programs like pro-bono or skills-based volunteer initiatives.
• Manage the Lift by GuideWell program including the application process, promotion and awareness of program, fundraising and managing inquiries from employees.
• Lead the strategy, development and execution of internal and/or external special events and statewide corporate initiatives (HeartWalk, food drives, blood drives, etc.).
• Manage team of employee volunteers/engagement council and/or contractors/consultants as assigned. Determine best approach to coordinate Employee Engagement program and local community engagement initiatives.

Senior Employee Engagement Manager

Auditor

• Support the risk analysis function through the information-gathering process, assessment of supporting technologies, and development of the audit program. Collaborate with Audit team management regarding audit program development.
• Perform research on technologies included in the scope of audits, identifying assessment focus areas based upon risk analysis.
• Execute key control testing through detailed analysis of various technical environments including operation systems, databases, network components and devices, and the related IT processes to manage those environments.
• Communicate with audit stakeholders regarding audit process and activities, artifact request management, risks, and audit results.
• Track auditee remediation plans adopted to mitigate significant risks.
• Lead most aspects of the project lifecycle for assigned audit engagements including preliminary risk assessment and related technical research, project management, communication with audit team and business stakeholders.

Senior Systems Auditor, IT Support

QA Engineer

• Creates a test approach, identifying scope of testing with risk-based approach for each feature or scope of work in a project effort identifying test environments, dependencies, constraints, prioritizing test cases and scheduling time for the testing.
• Responsible for ensuring end to end testing methodology including all appropriate documentation and requirements. Ensures tests are accurate thorough and appropriately documented.
• Sets up software and hardware in the test lab, per specs. Ensures test results are accurate, thorough and appropriately documented.
• Communicates results and coordinates logistics to the Systems Analysts, Developers, and other key IT staff and leadership as appropriate.
• Documents problems or results inconsistent with expected results.
• Performs quality assurance tests on all work and performs detailed analysis on all results.
• Certifies application for release to the next testing stage or to the production environment. Generates and distributes periodic status reports for testing.
• Executes automated test scripts.
• Writes/coordinates resolution of system defects. Ensures appropriate hand-offs and retesting.
• May provide technical guidance to other IT Testing Specialists.

Software QA Analyst

• Lead Audit Engagements: Lead audit engagements from planning to execution, identifying observations and providing recommendations to stakeholders.
• Audit Planning and Execution: Learn business processes, identify risks, develop and execute audit plans, perform detailed analyses, and evaluate internal controls.
• Collaboration and Implementation: Collaborate with audit management and business stakeholders to implement changes and ensure compliance with policies and procedures.
• Data Analytics and Insights: Utilize data analytics and AI to identify trends, risks, and opportunities for improvement in business operations and processes.
• Regulatory Audits: Facilitate audits with regulatory agencies or 3rd parties.
• Reporting and Communication: Develop and communicate audit findings and results through clear and concise, meaningful reports and presentations.

Senior Internal Auditor

Procurement

• Identify Supply Needs: Utilize industry knowledge to determine local and regional supply needs, methodologies, and approaches for acquiring goods and services.
• Align Business Partner Goals: Collaborate with internal business partners, conducting research and assessments to understand their needs and expectations.
• Communicate Procurement Procedures: Translate purchasing procedures to internal business partners and suppliers using technical knowledge and communication skills.
• Provide Contractual Advice: Offer general contractual and commercial advice to internal business partners and other stakeholders.
• Negotiate with Suppliers: Obtain and respond to competitive price quotes, negotiating procurement details with suppliers.
• Drive Cost Savings: Purchase specialized or complex materials, equipment, and services while achieving significant cost savings.
• Build Supplier Relationships: Develop and maintain strong relationships with internal business partners and key suppliers to improve performance.
• Develop and Achieve Objectives: Create and achieve objectives for cost management, supplier management, and process improvements.
• Resolve Conflicts: Address conflicts concerning materials or services at the department and supplier levels.
• Continuously Improve Processes: Evaluate and recommend improvement opportunities, collaborating with stakeholders and department input to drive process improvements.

Buyer – Procurement

• Provide field service support and coordination to specific assigned key complex group customers.
• Work with Account Manager on development and execution of Account Management Plan
• Develop and maintain strong partnerships with assigned accounts and their business partners as well as other key influencers
• Achieve an understanding of client’s organization and business processes, both formal and informal
• Educate accounts on BCBSF sales process, products, policies, and procedures and support the appropriate execution
• Act as liaison or key point of contact between account, business partner, TPA’s, reinsurers, BCBSF and other BCBS plans
• Facilitate the interface between client and BCBSF staff and management
• Manage and conduct the development, coordination and distribution of enrollment materials, enrollment/education meetings, administrative requirements
• Represent BCBSF in competitive enrollment situations and influence selection of BCBSF as the employee’s insurance choice
• Develop and implement account tactical plans based on needs analysis and continually update strategy as the situation changes
• Monitor account management to provide value added impact for renewal decision making
• Facilitate and coordinate multiple projects and tasks with external community partners and internal organizational partners

Account Management Specialist II

Data Scientist

• Development of departmental data
• Ensuring data quality for Actuarial analyses
• Assisting with architecture development and monitoring of corporate data (EDW)
• Assisting with reserving, trend setting, and financial forecasting
• Manage, coach and mentor staff Data Analysts

Actuarial Data Manager

Project Manager

• Maintain a "Zero-Delay" content calendar for multiple brands, ensuring all YouTube publishing is timely and optimized.
• Lead the systematic "Audit Loop" to proactively identify and refresh outdated digital content, including links, deadlines, and school-specific application data.
• Manage the annual onTrack update cycle during "Update Season" (June–August), ensuring 100% accuracy of platform data as school applications are released.
• Write and optimize video metadata, including titles, descriptions, and timestamps, to maximize SEO and lead-generation potential.
• Monitor and report on YouTube and platform analytics, providing actionable insights to the leadership team to drive engagement and enrollment.
• Oversee the outreach and management of the onTrack Fellowship Program and potential organizational partnerships to expand onTrack’s reach.
• Coordinate all logistics between internal stakeholders and our outsourced professional production team to ensure a seamless "traffic control" of video assets.
• Manage the external production budget by reviewing deliverables for quality and ensuring peak efficiency in editing spend.
• Schedule and facilitate regular video shoots, including coordination with scriptwriters, administrative support, and external guests.
• Act as the primary Tech Support Liaison for the onTrack platform, collaborating with developers and consultants to manage sales initiatives, implement platform updates, resolve user issues, and communicate technical changes to the customer service team.
• Develop and document standard operating procedures (SOPs) for content workflows to ensure institutional knowledge is preserved and scalable.

Project Manager, Digital Content – Operations

Claims Specialist

• Day-to-day processing of claims for accounts:
• Responsible for processing of claims (medical, dental, vision, and mental health claims)
• Claims processing and adjudication.
• Claims research where applicable.
• Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic).
• Incumbents are expected to meet and/or exceed qualitative and quantitative production standards.
• Investigation and overpayment administration:
• Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers.
• Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records.
• Utilize systems to track complaints and resolutions.
• Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading.

Claims Examiner I – Part Time

Account Executive

• Develop, coordinate and implement strategies and plans associated with all aspects of renewals for groups of 50-499, including Diversified Business, new sales and renewals.
• Accountable for coordination of marketing service efforts in a manner that facilitates the retention and effective administration activities of assigned accounts by assuring that Florida Blue delivers appropriate service to all group administrators, employees and agents.
• Maintain relationships with key contacts and provide a mutual understanding of the plans, policies and procedures to ensure group’s expectations are met.
• Manage and conduct the development, coordination and distribution of enrollment materials and enrollment educational sessions.
• Build strong partnerships with agents and individuals internal/external to the sales organization who support servicing, renewing and selling of our products.
• Develop and maintain strong partnerships with a specific assigned group of agents.
• Educate agents on Florida Blue sales processes, products, pricing, policies and procedures.
• Act as liaison or key point of contact between agent and Florida Blue.
• Build strong relationships with individuals within and outside the sales organization who support retention of our products.
• Manage the agent through the Florida Blue sales process to achieve retention goals through collateral material, proposal and rating, influencing RFP's, closing/acquisition, objection handling, and enrollment/implementation.
• Create commitment to Florida Blue by moving agent to higher levels (Gold and Blue Diamond).