Senior Compliance & Policy Specialist

GuideWell; United States; Hybrid; USD 78,000 - 126,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Retirement plan

Paid time off

Hybrid work arrangement

Job summary

GuideWell is seeking a seasoned compliance professional to support CMS/NCQA requirements and UM programs at Florida Blue. You will identify risks, evaluate controls, lead audits, and implement compliant policies across departments to ensure regulatory adherence and high-quality business outcomes.

The role involves developing programs, presenting findings, mentoring teammates, and coordinating complex projects in a hybrid work setting, with comprehensive benefits and competitive compensation.

Qualifications

• 5+ years related work experience.
• Bachelor’s degree or related equivalent work experience
• Audits demonstrating compliance with policies and regulations
• Experience leading large, complex projects with PM standards
• Identify risks and implement compliance programs

Responsibilities

• Serve as a liaison between internal clients and functional departments; help clients achieve their objectives by interpretation and compliance with policies, laws and procedures.
• Identify risks, evaluate controls and prepare findings; implement compliance programs to prevent improper business practices.
• Monitor and evaluate the effectiveness of solutions and report improvements for high-quality outcomes.
• Develop, implement and revise policies, procedures and programs to meet business needs and lead program enhancements.
• Research, analyze and prepare data used in business decisions; present findings clearly.
• Produce, edit and distribute reports, audits, proposals and other business documents.
• Create and facilitate meetings, trainings and webinars for diverse internal and external audiences.
• Represent the function at external hearings, audits and meetings.
• Lead or participate in large projects; plan, organize and report on progress.
• Build internal and external partnerships to improve collaboration and communication.
• Mentor and coach teammates on technical and interpersonal skills.
• Support Florida Blue's UM department to ensure CMS/NCQA compliance.

Skills

Audits

Regulatory compliance

Risk assessment

Policy development

Project management

CMS/NCQA knowledge

Education

Bachelor's degree or related equivalent

Job description

GuideWell is seeking a seasoned compliance professional to support CMS/NCQA requirements and UM programs at Florida Blue. You will identify risks, evaluate controls, lead audits, and implement compliant policies across departments to ensure regulatory adherence and high-quality business outcomes.

The role involves developing programs, presenting findings, mentoring teammates, and coordinating complex projects in a hybrid work setting, with comprehensive benefits and competitive compensation.