GuideWell Source

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

Account Manager

• Oversee team efforts to exceed school and educational consultant lead goals
• Develop reporting cadences, dashboards, and manual workarounds
• Scaffold our highly experienced and mission-driven team to thrive
• Lead our talented, mission-driven team to scale their work of tutoring partnerships

Senior Director of Tutoring Partnerships

Security Engineer

• Accountable for adhering to enterprise architecture standards, ensuring security technology standards and best practices are maintained across the organization and contributing to enterprise architecture strategy-setting.
• Responsible for design and implementation of security strategy, architecture and platforms. Responsible for enterprise due-diligence activities including security monitoring and security metrics to evaluate effectiveness of the enterprise security program and established controls.
• Responsible for ensuring necessary security controls are part of technical designs.
• Participates in security governance processes.
• Participates in IT security efforts across all business areas and client groups.
• Troubleshoots, recommends and executes action plans for issue resolution.
• Serves as security architecture subject matter expert to business areas, project teams and vendors to apply and execute appropriate use of technology solutions and lead efforts to examine technology vision, opportunities and challenges.
• Builds consensus around principles of security architecture and interprets and clarifies these principles.
• Participates in the evaluation, selection and implementation of technology solutions including providing detailed analysis of pros and cons and build vs buy options.
• Provides technical guidance to less experienced Security Architects.
• Participates on project teams contributing input with regard to security standards and the impact to technology.
• Investigates and reports on security threats and incidents.
• Conducts post-event reviews of security incidents.
• Maintains operational, architectural and design documentation including procedures, task lists, and architecture blue prints.
• Evaluates strengths and flaws in Security Architecture designs including performance, confidentiality, integrity, availability, access and total cost of ownership.
• Facilitates project handoffs including preparing documentation, educating and supporting to ensure smooth transitions.
• Selects and designs tools that allow reuse of design components and patterns between projects. Develops actual working solutions or prototypes based on their own designs and resolves any issues that arise.
• Establishes and maintains relationships with IT and business area partners to evaluate designs and controls.
• Continually works to enhance breadth and depth of knowledge and experience. Benchmarks technology strategies and architectures. Monitors and anticipates trends and investigates organizational objectives and needs. Provides guidance on security solutions and prepares benchmarking reports and presentations.
• Promotes implementation of new technology, solutions and methods to improve business processes, efficiency, effectiveness and value delivered to customers.

Claims Examiner I

Senior Director of Tutoring Partnerships

Senior Cybersecurity Architect