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:
The Sr Specialist, Interoperability, EDI & Product Management, Provider Connectivity Solutions role applies their discipline-specific knowledge of Electronic Data Interchange (EDI), X12 & HL7 standards and CMS/ONC Regulatory Compliance or institutional knowledge and skills in the performance of departmental activities which support the operations of the Company.
Additionally, they prepare for their role by either earning a post-secondary degree in a specific field or by on-the-job training and work experience. Incumbents may directly manage a small number of employees (two or less); the primary function of the role is applying specialized knowledge and skills as an exempt-level individual contributor.
This role performs activities that support the success of our Provider Experience, Clinical and Workflow operations, HEDIS/Quality ratings, and the Provider Network Solutions scorecard. Supports, contributes, and works with their manager to execute the Provider Connectivity Solutions strategy.
The essential functions listed represent the major duties of this role, additional duties may be assigned.
- Engaging business stakeholders for enhancing existing and launching new products.
- Branding and customer communication required to gain adoption of a new product.
- Monitor, maintain and test the Company’s systems that manage business and work processes.
- Research, analyze, synchronize, maintain, modify, interpret, validate, and prepare data, information and content used in making business decisions.
- Develop tools and systems to manage this information.
- Help clients understand and comply with internal and external standards and practices.
- Identify risks, evaluate controls, and prepare findings and recommendations. Implement compliance programs to prevent illegal, unethical, or improper business practices.
- Monitor and evaluate the effectiveness of solutions, policies, practices, and processes to ensure continuous improvement, good client relations, compliance and adherence to business and system requirements.
- Recommend improvements to achieve and deliver high quality, value-added services.
- Administer programs that meet business needs; may assist with program development and enhancements.
- Ensure through audits that the organization’s programs are consistently administered in compliance with organizational policies and procedures, contractual obligations, rulings, laws, and government regulations as applicable.
- Coordinate, produce, and distribute a variety of business documents such as reports, system and process documentation, audit results, newsletters, brochures, etc.
- Translate business needs and deliverables into technical specifications and requirements.
- Engage with director-level leadership on work deliverables, status communications and escalated issues.
- Mentor and coach less experienced and Specialist II or Specialist I coworkers on the technical and interpersonal skills needed for effective job performance.
- May be delegated as lead SME and/or decision maker on advanced projects and workgroups or initiatives.
- Support, participate in, or mid to advanced components of projects. Carry out tasks and activities that support project plans and deliverables.
- May participate in department/divisional workgroups and initiatives.
- May participate in Industry workgroups and standards organizations (webinars, listserves, summits) such as X12, HL7, WEDI, eSolutions Xchange, HIMSS, Availity Connects
What you will need
Experience:
• 3+ years of related work experience
• Experience managing technology vendor relationships; RFI submissions, Reviewing/Redlining MSA/SOWs, contract negotiations, SLA monitoring and enforcement
• Experience managing tasks independently and take ownership of responsibilities.
• Thorough knowledge of Information Technology fields and computer systems – Experience learning from mistakes and applying constructive feedback.
• Experience communicating technical information clearly and articulately.
• Ability to adapt to a rapidly changing environment.
• Experience with Product Management, Product Discovery, Planning & Development
• Experience with business requirements and business process analysis to ensure IT solutions meet the business needs
• Thorough knowledge and experience of systems, subsystems, development methodologies, systems architecture, tools, and processes that support the assigned business initiative or system
• Understanding of and Agile processes and disciplines
• Understanding of typical architecture standards and ability to apply them in their design work
• High critical thinking skills to evaluate alternatives and present solutions that are consistent with business objectives and strategy.
• Knowledge of systems development concepts and methods
• Experience in applying research methodology to business solutions.
• Ability to lead and facilitate project team status meetings to obtain schedule, issues, risk, and dependency updates.
• Ability to document meeting minutes, action items from project status meetings.
• Ability to organize and prioritize workload.
Education:
• Related Bachelor’s degree or additional related equivalent work experience
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 program
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: $76,900 – $124,900
Typical Annualized Hiring Range: $76,900 – $96,100
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.