Get to know us!
Florida Blue, a GuideWell Company, has been providing insurance to residents of Florida for 75 years. Driven by its mission of helping people and communities achieve better health, the company serves more than five million healthcare members across the state. We are looking for exceptional people who will bring our mission to life and succeed by putting the member first.
Let’s talk benefits!
When it comes to our benefits, we offer a total compensation package including competitive base pay, health insurance, 401(k), as well as work-life balance programs. We design our offerings to take care of you-to help you be your best at work and in life.
What you will do:
Consultants are seasoned subject matter experts who apply specialized knowledge, typically as an individual contributor, in matters that require special interpretation or expertise. Incumbents use their discipline-specific and/or institutional knowledge to perform department activities. They participate in and/or lead critical, high-risk, complex initiatives, programs, and projects, have frequent contact with internal and external business partners, facilitate/ influence strategic thinking and direction and influence peers and leaders across the organization to act on issues that have organization-wide impact. Incumbents may directly manage a small number of employees (two or less); the primary function of the role is consulting.
The essential functions listed represent the major duties of this role, additional duties may be assigned:
- Provides consultative support to organization management within context ofthe Independent Dispute Resolution (IDR) process.
- Provide expertise on and/or lead critical or complex initiatives and projects from concept through analysis and design to operational business readiness and implementation
- Lead the design and development and/or integration of complex tools, systems, processes, programs, network expansions, etc. that directly impact business decisions and objectivesof the IDR Process.
- Leads projects related to changes or development of new or modified regulations to ensure IDR Program Compliance
- Advise management on options, opportunities, risks, solutions, cost versus benefits and impacts on business processes, systems, employees, etc. Influence and gain acceptance of ideas and suggestions.
- Rapidly learn current IDR processes and constraints to develop efficiencies of optimal business processes.
- Single point of contact for Internal/External resources for IDR cases
- Facilitate negotiations / negotiate rates with non-par providers.
- Collaborates with Legal, Network, Finance on contracting efforts, rate negotiations, Regulatory Compliance
- Collaboration across Legal, Analytics, PIO regarding QPA / NP Rates
- Collaborate with IDR Entities on IDR cases.
- Communication with leadership provides full transparency.
- Data-driven analysis and prioritization of complex tradeoffs
- Manage and develop internal and external relationships and work successfully across technology and business stakeholders, including peer level through executive level
- Has frequent contact with internal and external business partners to obtain and share information for influencing decisions, and/or providing advice and counsel that impacts business objectives including IDR compliance efforts and network strategies.
- Acts as communications lead for the IDR Team. Expertise in document creation and communications at all levels.
- Communication includes and to all levels throughout the organization.
- Acts as spokesperson for leadership, as appropriate.
- Exceptionally strong analytic capabilities and the ability to use data to ‘hone in’ and determine the highest-value projects to pursue
- Expertise and comfort in document creation, and communication of required process changes
- Knowledge of different process design methodologies and their practical application.
- May oversee reporting, monitoring, and evaluation activities.
- Serve as Subject Matter Expert and mentor others.
What you will need
Experience:
- 5+ years related work experience. Experience Details: Healthcare, Network Management,
- Proficiency with Microsoft suite of tools (Excel, Word, PowerPoint)
- Bachelor’s degree or equivalent experience
- Proficiency with Teams and / or SharePoint PMP
- Must be able to travel to multiple locations for work (i.e., travel to attend meetings, events, conferences). Occasionally
- Experience in Negotiating rates/contracts with Providers
- In-depth knowledge of physician, ancillary or HBP contracts
- Familiar with Diamond Claims systems and Bluecard processes
Preferred Qualifications:
- Proficiency with Teams and / or SharePoint PMP
- Master’s degree
General Physical Demands:
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
Physical/Environmental Activities: Must be able to travel to multiple locations for work (i.e., travel to attend meetings, events, conferences). Occasionally
What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
- Medical, dental, vision, life, and global travel health insurance.
- Income protection benefits: life insurance, Short- and long-term disability programs.
- Leave programs to support personal circumstances.
- Retirement Savings Plan includes employer contribution and employer match.
- Paid time off, volunteer time off, and 11 holidays
- Additional voluntary benefits available; and
- A comprehensive wellness programs
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Annualized Salary Range: $83,800 – $136,200
Typical Annualized Hiring Range: $83,800 – $104,800
Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
When you become part of the GuideWell family, you help bring our mission to life by helping people and communities achieve better health.
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.