Jobs at GuideWell

Processes and adjudicates medical, dental, vision, and mental health claims; researches benefits, coverage, medical necessity, appeals, complaints, and overpayments. Reviews medical records, coordinates settlements and recoveries, verifies plan loading, authorizes payments, and maintains accurate claim and provider records while meeting production standards.

Processes and adjudicates medical, dental, vision, and mental health claims; researches benefits, coverage, medical necessity, and clinical edits. Investigates and recovers overpayments, handles appeals and complaints, interprets medical records, verifies plan loading, and authorizes payments. The role requires meeting production standards, maintaining accurate records, communicating with providers and clients, and using claims, coding, and Microsoft applications.

Processes and adjudicates medical, dental, vision, and mental health claims; researches coverage, medical necessity, benefits, appeals, and plan loading. Investigates and recovers overpayments, interprets medical records, handles complaints, negotiates settlements, and authorizes payments. The role requires claims-system experience, CPT and ICD-10 coding knowledge, familiarity with healthcare regulations, accurate data entry, sound judgment, and effective communication with providers and clients.

Processes and adjudicates medical, dental, vision, and mental health claims. Reviews coverage, medical necessity, coding, plan benefits, and policy guidelines; investigates claims, manages overpayments and recoveries, resolves appeals, researches complaints, and verifies plan loading. The role requires accurate production, claims analysis, provider communication, medical record interpretation, and use of computerized claims systems.

Processes and adjudicates medical, dental, vision, and mental health claims; researches coverage, medical necessity, benefits, and plan loading. Investigates overpayments, negotiates settlements, interprets medical records, handles appeals and Department of Insurance complaints, authorizes payments, and maintains accurate financial histories. The role requires meeting production standards and applying knowledge of coding, policy guidelines, HIPAA, COBRA, coordination of benefits, and reasonable and customary fees.

Supports actuarial management through a three-year rotation program across actuarial and related business teams. Performs pricing, trend, forecasting, reserving, network, segment, provider value, gross margin, and financial analyses for ACA, Medicare, Group, and other insurance lines. Develops actuarial science and insurance expertise while progressing toward the FSA designation. The role is open to remote or in-person candidates.

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.

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.

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.