What is your impact:
Specialists apply discipline-specific or institutional knowledge and skills in the performance of departmental activities which support the Company's operations. Specialists typically prepare for their role by earning a post-secondary degree in a specific field, obtaining certification, or by on-the-job training and work experience. Incumbents may directly manage a small number of direct reports; the primary function of the role is applying specialized knowledge and skills as an exempt-level individual contributor.

What are your responsibilities:

• Serve as a liaison between internal clients and functional departments; help clients achieve their objectives by serving as a resource in the interpretation, application and compliance with internal and external laws, regulations, policies, procedures, standards, and practices.
• Identify risks, evaluate controls, and prepare findings and recommendations. Implement compliance programs to prevent illegal, unethical, or improper business practices.
• 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.
• Monitor and evaluate the effectiveness of solutions, policies, practices, and processes to ensure continuous improvement, good client relations and adherence to business requirements. Recommend improvements to achieve and deliver high quality, value-added services.
• Develop, implement, administer, and revise policies, procedures and programs that meet business needs; assist and/or lead program development and enhancements.
• Research, analyze, maintain, modify, validate, and prepare data, information and content used in making business decisions. Present findings and articulate results.
• Produce, edit, and distribute a variety of business documents such as reports, proposals, policies, procedures, audit results, issue papers, marketing materials, newsletters, brochures, etc.
• Create, present and/or facilitate meetings, webinars, conference calls, training programs, education sessions, certifications, etc. for a variety of internal and external audiences.
• May represent assigned function at external hearings, mediations, audits, meetings, etc.
• Participate on or lead larger, more complex departmental and/or divisional projects. Plan, organize, monitor, and control projects to ensure the effective use of resources and adherence to project management standards and reporting requirements.
• May participate on Company workgroups and initiatives.
• Develop and build internal partnerships to improve communication, coordination, collaboration, and effective working relationships within own department and across the Company.
• May mentor and coach less experienced coworkers on the technical and interpersonal skills needed for effective job performance.

What is required:
4+ years related work experience

Related bachelor’s degree or additional related equivalent work experience

What is preferred:

Experience Details includes: Clinical experience, provider relations, HEDIS, and/or Medicare Stars

Project management experience

Familiarity with HEDIS process including evaluating member compliance and identifying opportunities

Experience working with 3rd party Healthcare stakeholders, i.e. vendors and providers

Healthcare Insurance background

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.

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, 10 holidays and two flexible Well-Being days

• 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: $62,500 - $101,500
Typical Annualized Hiring Range: $62,500 - $78,100

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.