Jobs at GuideWell

Lead GuideWell's executive thought leadership strategy and execution, owning leader LinkedIn, speaking pipeline, executive coaching, cross-functional integration, and measurement to advance enterprise narrative and reputation.

Performs advanced actuarial analysis of health insurance issues, rates, underwriting criteria, forecasts, variances, provider contracts, benefit designs, and financial performance. Supports all lines of business, product development, delivery systems, regulatory compliance, and cross-functional workgroups. Provides leadership and develops Actuarial Analysts while operating with minimal supervision.

Lead teams and manage a portfolio of network development, management, and operations programs. Ensure regulatory compliance (CMS, AHCA, NCQA, BCBSA), implement scalable processes, manage budgets (~$3.5M/project), coordinate cross-functional stakeholders, maintain provider/network documentation, and support sales RFI/RFP and reporting activities.

Lead end-to-end strategic sourcing and contract negotiations for mid-to-high complexity acquisitions. Collaborate with Legal, Compliance, IT and business stakeholders, manage RFI/RFP/RFQ processes, evaluate vendors using scoring matrices, and draft/execute contracts ensuring regulatory and risk compliance (HIPAA, CMS, FEP). Drive process improvement, vendor accountability, and produce executive summaries and management reporting to support decision-making.

Manage procurement contracts and Master Service Agreements, including review, drafting, redlining, negotiation, risk mitigation, compliance, dispute resolution, and vendor management. Serve as liaison between Procurement, Legal, sourcing teams, and suppliers. Provide contracting strategy and training, monitor contract performance indicators, and support continuous improvement of contracting processes, templates, and documentation.

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.

Provide senior consultative support for network business operations and program management, leading complex initiatives from design to implementation, advising leadership, developing processes and tools, using data to prioritize high-value efforts, managing stakeholders, communications, and occasionally supervising a small team.

Leads enterprise cybersecurity architecture for AI, cloud, hybrid, and on-premises environments. Designs secure AI architectures, cloud foundational controls, zero-trust identity models, API and data protections, and secure LLM, RAG, agent, and MCP integrations. Establishes governance, reusable security patterns, model-usage procedures, compliance controls, and audit readiness across AWS and Azure. Advises executives and technical teams, mentors security professionals, and drives secure cloud migrations while addressing AI/ML risks such as adversarial attacks, model poisoning, data drift, bias, and data leakage.

Processes and adjudicates medical, dental, vision, and mental health claims; researches benefits, coverage, medical necessity, and plan configurations. Investigates and recovers overpayments, resolves appeals and complaints, interprets medical records, negotiates settlements, and authorizes payments. Maintains accurate claims and financial records while meeting production standards and communicating with providers, clients, and healthcare facilities.

Processes and adjudicates medical, dental, vision, and mental health claims; researches benefits, coverage, medical necessity, and plan guidelines. Investigates and recovers overpayments, manages complaints and appeals, interprets medical records, authorizes payments, and maintains accurate claim and financial records. The role requires meeting production standards, using claims and coding systems, and communicating effectively with providers, clients, and healthcare facilities.

Leads Commercial Markets Operations intelligence, business intelligence, analytics, reporting, dashboards, and strategic information initiatives. Manages analysts, develops performance metrics, oversees operational reporting, supports executive decision-making, and drives process improvement. The role also manages resource planning, budgets, stakeholder alignment, SharePoint stewardship, and adoption of innovative information solutions across Sales Operations and Commercial Markets.

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.