Senior Manager, Federal IDR

GuideWell; United States; Presencial; USD 109.000 - 178.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical insurance

Dental insurance

Vision insurance

Life insurance

Global travel health insurance

Disability (short & long term)

Leave programs

Retirement Savings Plan with employer

Paid time off

Volunteer time off

Holidays and well-being days

Wellness program

Descripción de la vacante

GuideWell is seeking a Senior Manager, Federal Independent Dispute Resolution (IDR) to lead IDR specialists and drive No Surprises Act compliance while aligning with enterprise strategy for Florida Blue. You will oversee budgeting, vendor performance, and technology enablement, partnering with IT to automate and improve processes.

The role requires 6+ years in health insurance/managed care with people leadership, a business-focused degree, and strong analytical and stakeholder skills to

Formación

• Six years or more in health insurance/managed care with progressive leadership.
• Bachelor’s degree in business, healthcare administration, finance, or related field; advanced degree preferred.
• Working knowledge of the federal No Surprises Act and the IDR process.
• Experience managing large budgets, forecasting, and vendor performance/contract compliance.
• Experience acting as a business or product owner for technology solutions.
• Proven ability to translate regulatory and financial information into clear recommendations.

Responsabilidades

• Lead, coach, and develop a high-performing team of IDR specialists.
• Plan, organize, and direct department activities to meet compliance metrics and KPIs.
• Own IDR technology solutions, define requirements, and prioritize the roadmap.
• Oversee vendor programs, ensure contract compliance and SLAs.
• Collaborate across Network, Legal, Compliance, Account Management, and Claims.

Conocimientos

Team Leadership

Budget management

Vendor management

Regulatory compliance

IDR process knowledge

Product ownership

Cross-functional collaboration

Educación

Bachelor's degree in business, healthcare administration, finance, or related field

Descripción del empleo

All of our team members and contributors are expected to deliver results with accountability while collaborating seamlessly across boundaries. They embrace change with resilience, staying curious and learning continuously in a rapidly evolving landscape. Grounded in business understanding and comfortable with AI and digital tools, they solve problems with critical thinking and creativity. Above all, they are driven to serve—ensuring their work creates meaningful impact for members and the community we support.
For leadership roles, we seek individuals who think critically, embrace a future-focused mindset, and bring intentional perspective to their work —whether managing people, leading projects, or guiding teams. Our ideal candidates operate across matrix environments, applying systems thinking and evidence-based decision-making to drive sustainable results with economic discipline. We value those who lead change with courage and conviction, building trust across teams, and orchestrating both human and AI capabilities to amplify impact. Across all roles - managing direct reports, leading projects, or advancing individual expertise - they cultivate resources, strengthen capabilities, and create conditions for people and work to thrive. Above all, they are committed to building durable value—decisions and actions today that compound organizational strength tomorrow.

Job Summary:
The Senior Manager, Federal Independent Dispute Resolution (IDR) is accountable for the end-to-end operation and influence Florida Blue’s strategy in response to the No Surprises Act IDR process. The role blends operational excellence with enterprise strategy: directing a team of IDR specialists, ensuring regulatory compliance, vendor performance, and technology enablement, while aligning offer strategy with Network priorities. Working across Network, Legal, Claims, Account Management, IT, and Compliance, the Senior Manager provides leadership with the insight needed to manage IDR exposure and drive better outcomes for the enterprise, our members, and self-funded groups.

Essential Functions:

• Team Leadership: Lead, coach, and develop a team of IDR specialists; recruit, motivate, and retain talent to build a high-performing team that consistently achieves target results.

• Operational Performance: Plan, organize, direct, and control all activities of the department, managing performance across people, process, and technology to achieve regulatory compliance metrics, timelines, and KPIs under the No Surprises Act.

• Product Ownership: Act as product owner for IDR technology solutions by defining business requirements and design, prioritizing the roadmap, and partnering with IT to support automation and continuous improvement efforts.

• Vendor Management: Implement and oversee vendor programs, ensuring contract compliance and attainment of vendor SLAs through active governance, performance reviews, and corrective action when needed.

• Network and Policy Integrator: Serve as an integrator, providing feedback to the policy team and Network to influence and drive better outcomes in IDR and for the enterprise, supporting overall network strategy, informed by arbitration results and regulatory developments.

• Financial Management: Manage budgets of $30M+, ensuring disciplined stewardship and clear accountability for results against plan.

• Forecasting: Provide input into forecasts for IDR fees and medical expense based on IDR receipts, outcomes, and emerging experience trends.

• Cross-Functional Collaboration: Collaborate with key stakeholders, including Network, Legal, Compliance, Account Management, and Claims, to resolve issues and mitigate risks to the Enterprise, exercising influence, interaction, and decision-making that spans the division and unit levels.

• Navigating Complexity: Collaborate through the complexities of coordinating across multiple areas, conflicting efforts, and limited resources to keep priorities aligned and work moving forward.

• Enterprise Impact Analysis: Define potential financial, business, and industry impacts, engaging key stakeholders across Legal, IT, Compliance, Claims, and other areas of the company.

• Executive Reporting: Provide insight and prepare reports for senior leadership on IDR performance, trends, and financial exposure.

• Communication and Influence: Demonstrate exceptional written and verbal communication for internal and external audiences, including executive presentations, influencing stakeholder decisions, and meeting with self-funded groups and providers.
  

Required Experience:

• 6+or more years of progressive experience in health insurance, managed care, claims, provider contracting, or a related field, including at least three years in a people leadership role.

• Bachelor’s degree in business, healthcare administration, finance, or a related field required; advanced degree preferred.

• Working knowledge of the federal No Surprises Act and the IDR process, including the arbitration process, qualifying payment amount (QPA), and applicable regulatory timelines and requirements.

• Demonstrated experience managing large budgets, forecasting, and vendor performance and contract compliance.

• Experience acting as a business or product owner for technology solutions, including requirements definition and continuous improvement.

• Proven ability to translate complex regulatory and financial information into clear recommendations for senior leaders.

• Strong analytical, influencing, and stakeholder management skills, with the ability to balance operational detail and strategic vision.
  

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 be at the heart of GuideWell’s vision – to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.
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 including employer match;
• Paid time off, volunteer time off, 10 holidays and 2 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: $109,300 - $177,600
Typical Annualized Hiring Range: $109,300 - $136,600
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 Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.