Specialist III - Healthcare Business Support

Florida Blue Group; Jacksonville (FL); Hybrid; USD 78,000 - 126,000; Full time

Benefits offered by this job

Health insurance

Retirement plan with employer match

Paid time off

Wellness program

Job summary

Florida Blue seeks a seasoned compliance professional to join its UM support team in Jacksonville. You will interpret laws, develop policies, and coordinate audits, ensuring programs meet CMS, NCQA, and Florida statutes while guiding cross-functional teams.

The role emphasizes project leadership, risk assessment, and data-driven reporting; expect collaboration across departments, mentoring, and opportunities to influence enterprise-wide compliance and data integrity within a hybrid work model.

Qualifications

• Minimum 5+ years of relevant work experience in compliance or related fields.
• Experience conducting audits to ensure adherence to organizational policies and regulatory obligations.
• Ability to lead large, complex projects with resource planning and reporting requirements.

Responsibilities

• Serve as liaison between internal clients and departments to ensure compliance with laws, policies and procedures.
• Identify risks, evaluate controls and prepare findings and recommendations; implement compliant programs.
• Monitor and evaluate the effectiveness of policies and practices to drive continuous improvement.

Skills

5+ years related work experience

Compliance experience

Education

Bachelor's degree or equivalent

Job description

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 You Will Be Doing

• 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.
• 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.
• Represent assigned function at external hearings, mediations, audits, meetings, etc.
• Participate on or lead large, 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.
• Participate on Company workgroups and initiatives.
• Develop and build internal and external partnerships to improve communication, coordination, collaboration and effective working relationships within own department, across the Company and outside of the Company.
• Mentor and coach less experienced coworkers on the technical and interpersonal skills needed for effective job performance.
• Provide support to Florida Blue's Utilization Management (UM) department by ensuring adherence to Centers for Medicare and Medicaid Services (CMS) requirements and National Quality Care Assessment (NCQA) accreditation standards.

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 organisational strength tomorrow.

What We Require

• 5+ years related work experience.
• Related Bachelor's degree or additional related equivalent work experience
• Demonstrated experience with audits that the organization's programs are consistently administered in compliance with organisational policies and procedures, contractual obligations, rulings, laws and government regulations.
• Proven experience leading large, complex departmental and/or divisional projects. Plan, organise, monitor and control projects to ensure the effective use of resources and adherence to project management standards and reporting requirements.
• Ability to Identify risks, evaluate controls and prepare findings and recommendations. Implement compliance programs to prevent illegal, unethical or improper business practices.
• As part of the interview process candidates may be required to complete compliance policy knowledge with business impact analysis.
• Knowledge of Medicare Advantage, Commercial, and ACA plan-specific UM compliance requirements (CMS, NCQA, FL Statutes)

What We Prefer

• FL active and unrestricted RN license or compact RN license
• Experience with Florida Blue UM processes and procedures
• Experience with NCQA accreditation standards and survey preparation
• Demonstrated experience with compliance documentation, policy implementation, and periodic compliance evaluation/quality audit methodologies
• Proven ability to align departmental practices with enterprise compliance standard

General Physical Demands

• Exerting up to 10 pounds of force occasionally to move objects.
• Jobs are sedentary if traversing activities are required only occasionally.
• This position offers a hybrid work arrangement which combines flexibility with office engagement. Team schedules are determine based on role requirements and business needs. Travel to and from our corporate offices may be required.

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.

Typical Annualized Offer/Hiring Range: $77,600 - $97,000

Annualized Salary Range: $77,600 - $126,100

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 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.