Contract Management, Performance Management & Reporting Responsible for program performance, including but not limited to the Care Partner's adherence to established SLA's, ROI, cross functional processes, etc. Contribute to the development and maintenance of Care Partner program performance scorecards Coordinate regular Care Partner meetings with internal business partne

Internal Audit Accountabilities o Execute audit procedures as outlined by Leadership including perform and document findings of quality accuracy reviews/quality audits of coding and documentation completed by Companies Internal Risk Adjustment Coders/Auditors to ensure consistency and accuracy of ICD 10 coding and industry standards. o Advise Companies Internal Coders/Aud

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 th

The Florida Blue Centers are vital to achieving our market segment objectives to deliver a best in class customer experience, create value for the membership, drive market share and profitable growth, and deliver a differentiated experience to drive long term retention of the membership.While on this team you will proactively manage prospective customers and members' expe

The Florida Blue Centers are vital to achieving our market segment objectives to deliver a best in class customer experience, create value for the membership, drive market share and profitable growth, and deliver a differentiated experience to drive long term retention of the membership.While on this team you will proactively manage prospective customers and members' expe

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 th

Accountant III professionals apply specialized knowledge, typically as individual contributors, in assisting management in accounting matters that require special interpretation or expertise related to the Federal Employee Program (FEP). Provides management with technical reporting, financial analysis, and resolution of issues for accounting and reporting compliance relat

Owns and leads overall process for regular product performance reporting and annual portfolio reviews for all segments, inclusive of setting deadlines, managing key deliverables, facilitation of cross functional workgroups, development of key messaging of results for senior management and coordination with Segment Leads Owns product performance analysis, ad hoc reporting

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 an

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 th

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 an

Performs medical record validation audits and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives. Performs risk adjustment validation audits using external Electronic Medical Records (EMR) system access. Pe

The Onsite Account Executive is responsible for managing and directing the front line relationship with the client including, but not limited to, key decision makers HR leadership, distributors (brokers), and C level partners, and internal staff delivering the total healthcare benefit solution. They are responsible for managing the relationship, performing analysis and as

The Senior Director Medicare Pharmacy Programs will provide strategic direction and support the VP, Medicare Pharmacy programs in driving growth, innovation and excellence in our Medicare pharmacy services. The Sr. Director will primarily be responsible for leading the management of our Medicare pharmacy clinical and Stars programs, developing, and implementing strategies

The Cybersecurity Endpoint Protection Manager is accountable for communicating, planning and providing leadership to their assigned team. Cybersecurity Managers provide direction to project and functional resources within and outside their reporting structure, gather, support and develop the resources needed to execute the plan, champion the tactical direction of work and