Jobs at GuideWell

Manages maternity cases for expectant mothers, including high-risk pregnancies, through patient assessment, care coordination, discharge planning, treatment-plan monitoring, resource identification, cost-effective care planning, utilization review, and health-plan authorization. Collaborates with patients, families, providers, employers, and community resources while documenting goals, outcomes, and care plans. Requires an RN license, clinical nursing experience, and patient assessment expertise.

Processes and adjudicates medical, dental, vision, and mental health claims; researches benefits, coverage, medical necessity, and clinical edits. Investigates and recovers overpayments, handles appeals and complaints, interprets medical records, verifies plan loading, and authorizes payments. The role requires meeting production standards, maintaining accurate records, communicating with providers and clients, and using claims, coding, and Microsoft applications.

Processes and adjudicates medical, dental, vision, and mental health claims; researches coverage, medical necessity, benefits, appeals, and plan loading. Investigates and recovers overpayments, interprets medical records, handles complaints, negotiates settlements, and authorizes payments. The role requires claims-system experience, CPT and ICD-10 coding knowledge, familiarity with healthcare regulations, accurate data entry, sound judgment, and effective communication with providers and clients.

Processes and adjudicates medical, dental, vision, and mental health claims. Reviews coverage, medical necessity, coding, plan benefits, and policy guidelines; investigates claims, manages overpayments and recoveries, resolves appeals, researches complaints, and verifies plan loading. The role requires accurate production, claims analysis, provider communication, medical record interpretation, and use of computerized claims systems.

Processes and adjudicates medical, dental, vision, and mental health claims; researches coverage, medical necessity, benefits, and plan loading. Investigates overpayments, negotiates settlements, interprets medical records, handles appeals and Department of Insurance complaints, authorizes payments, and maintains accurate financial histories. The role requires meeting production standards and applying knowledge of coding, policy guidelines, HIPAA, COBRA, coordination of benefits, and reasonable and customary fees.

Conduct exploratory and concept-validation research, usability studies, participant recruitment, and research strategy. Collaborate with designers, product managers, developers, marketers, and stakeholders to uncover user insights, guide product strategy, prioritize features, and improve experiences. Present compelling, data-driven findings and manage research projects from planning through delivery.

Build and operate AWS and Azure cloud platform foundations, including landing zones, multi-account structures, account vending, Terraform modules, guardrails, CI/CD, centralized monitoring, and configuration-drift remediation. Lead and mentor platform engineers, establish reference architectures and self-service patterns, review application designs, author architecture decisions, and represent the platform in governance forums. The role supports regulated environments, AWS GovCloud, and large-scale data center migration.

Owns cloud financial management across AWS and Azure by analyzing spend, designing allocation and tagging models, building showback and forecasting, managing commitments, and executing optimization. Partners with engineering, finance, and executive teams to embed cost efficiency into architecture, provisioning, and CI/CD. Responsibilities include anomaly detection, rightsizing, storage tiering, idle resource cleanup, budgeting, migration planning, and cost reporting.

Operate and improve production AWS workloads through automation, monitoring, patching, backups, certificate renewal, disaster recovery, and restore testing. Define operational readiness standards, manage SLOs and error budgets, respond to incidents, participate in on-call rotation, troubleshoot Windows and Linux compute, and create self-healing workflows. Partner with infrastructure teams to transition migrated workloads into steady-state support while maintaining runbooks and operational documentation.

Designs and governs enterprise cloud strategy across AWS, Azure, and GCP in multi-cloud and hybrid environments. Leads architecture standards, governance, security, migrations, modernization, containerization, infrastructure automation, and FinOps initiatives. Advises executives and business stakeholders, conducts architecture reviews, oversees enterprise migrations, develops compliance frameworks, and mentors technical teams. The role also leads cloud Center of Excellence activities and collaborates with vendors and managed service providers.

Leads enterprise AI enablement and intelligent automation, overseeing use-case intake, prioritization, delivery, governance, adoption, and value realization. Establishes the AI operating model, builds literacy and training programs, manages automation and AIM teams, sets responsible-AI guardrails, tracks adoption metrics, and aligns investment with enterprise transformation priorities. Requires executive stakeholder leadership, portfolio governance, team development, and experience scaling AI or automation capabilities in complex organizations.

Leads enterprise change management across a transformation portfolio, including operating model design, change communications, adoption programs, readiness assessments, training, stakeholder engagement, and resistance management. Owns change-readiness metrics and represents organizational impacts in governance decisions. Builds leadership capability and manages teams spanning operating model design, communications, and behavior change. Requires extensive enterprise transformation, change management, organizational design, and people leadership experience.

Supports actuarial management through a three-year rotation program across actuarial and related business teams. Performs pricing, trend, forecasting, reserving, network, segment, provider value, gross margin, and financial analyses for ACA, Medicare, Group, and other insurance lines. Develops actuarial science and insurance expertise while progressing toward the FSA designation. The role is open to remote or in-person candidates.

Leads enterprise cybersecurity architecture for AI, cloud, hybrid, and on-premises environments. Designs secure AI architectures, cloud foundational controls, zero-trust identity models, API and data protections, and secure LLM, RAG, agent, and MCP integrations. Establishes governance, reusable security patterns, model-usage procedures, compliance controls, and audit readiness across AWS and Azure. Advises executives and technical teams, mentors security professionals, and drives secure cloud migrations while addressing AI/ML risks such as adversarial attacks, model poisoning, data drift, bias, and data leakage.

Lead enterprise AI governance, risk management, and Responsible AI adoption. Oversee AI inventory, policy, risk lifecycle, regulatory compliance, vendor assessments, and integration of governance into business workflows. Partner with Legal, Compliance, Security, PMO, and business units to prioritize AI initiatives, report metrics and ROI, and advise executives and boards.

Senior leader responsible for enterprise acquisition marketing strategy and serving as CMX's strategic representative to the ACA segment. Leads acquisition planning, creative and communications, campaign operations, and local market/sales support. Mobilizes cross-functional CMX experts, oversees campaign execution across channels, ensures compliance, drives performance measurement and forecasting, and builds trusted relationships with segment leaders to align marketing to business growth targets.

Manage and grow relationships with mid-sized employer clients and distribution partners, ensure plan performance, lead cross-functional teams for implementations and renewals, drive retention and upsell, ensure compliance, and deliver exceptional client support and reporting.

Provide specialized corporate governance legal counsel to the Board and committees; prepare and manage Board materials; develop governance policies; advise on director qualifications, executive compensation, D&O matters, transactions, and compliance; coordinate with external stakeholders; manage governance records; conduct legal research and prepare opinions and memoranda.

Provide enterprise-wide legal counsel on federal and state healthcare regulatory matters. Monitor and interpret laws and enforcement activity, advise business units on compliance and regulatory strategy, develop policies, conduct regulatory risk assessments, coordinate with outside counsel, support compliance program implementation, respond to regulator inquiries, and prepare regulatory analyses for leadership and the Board.