GuideWell

Responsible for Medicare pricing, risk revenue analytics, and financial reporting across various segments. The role involves managing direct reports and participating in an Actuarial Rotation program to gain cross-functional experience.

The specialist ensures adherence to CMS and NCQA guidelines through auditing, risk evaluation, and the implementation of compliance programs. They also develop policies and serve as a liaison between internal clients and functional departments to improve operational quality.

The role serves as a liaison between internal clients and functional departments to ensure compliance with laws, regulations, and internal policies. Key duties include identifying risks, conducting audits, and developing process improvements to enhance service quality and operational efficiency.

Manage Tier 1 vendor programs and relationships, overseeing approximately 100 contracts worth $200M to ensure KPIs and SLAs are met. Develop program strategies, monitor financial performance, and act as a liaison for issue resolution and regulatory compliance.