GuideWell Source

• Manages cost reporting and analysis, planning, administrative cost controllership, and process improvements for the Federal Employee Program (FEP) segment, including the Federal Employee Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) Programs. • Prepares and provides consulting for complex analysis and costs reporting requirements, leads audits, continuous improvement projects, and other initiatives in support of the FEP segment. • Responsible for timely and accurate completion of periodic cost reporting, compliant with federal and BCBSA regulations. • Leads controllership, financial analysis and variance reporting for reimbursable allocated administrative expenses for FEHB and PSHB Programs. • Coordinates audit cycles to ensure accuracy of deliverables and adherence to deadlines, assigns, reviews and approves audit schedules prepared by Accountant II and III positions on staff. • Supports analysis and reporting for internal budgets and forecasts for the FEP segment. • Prepares management presentations and commentary for financial plans. • Continuously improving processes, developing efficiencies, and collaborating to resolve issues.

• Serve as the consistent, senior CMX presence in all segment leadership meetings, strategy sessions, and business planning forums — representing not just marketing, but the full Communications, Marketing & Customer Experience function. • Develop and maintain a deep, current understanding of each segment’s business strategy, competitive pressures, growth targets, operational challenges, and member or customer dynamics. • Listen to segment challenges with the breadth of the full CMX capability set in mind — identifying where marketing, communications, customer experience, brand, and insights each have a role to play, and framing integrated solutions rather than single-discipline responses. • Translate segment business needs into clear, actionable briefs for CMX subject matter experts — providing the strategic context, business rationale, and high-level direction that allows each SME to do their best work without needing to attend every segment conversation. • Mobilize and orchestrate the right CMX experts — across Communications, Customer Experience, Brand, Insights, and Marketing — for each segment challenge, ensuring the department delivers as one integrated function rather than a collection of independent capabilities. • Maintain a real-time understanding of priorities, capacity, and ongoing work across CMX disciplines, so that segment commitments are made with full awareness of what the department can deliver and when. • Serve as the accountability owner for CMX’s commitments to each segment — tracking deliverables, managing expectations, escalating risks, and ensuring the department consistently follows through on what it promises. • Build and sustain trusted, peer-level relationships with segment leaders in Commercial, Government, and Health Services — positioning CMX as a strategic partner that earns a seat at the table because of the value it creates, not because of its organizational role. • Proactively bring CMX insight, intelligence, and capability to segments before they ask — identifying opportunities where communications strategy, customer experience improvement, brand investment, or deeper audience insight could accelerate a segment’s goals, and making the case for that investment. • Report back to the VP, Enterprise Marketing & Acquisition and the broader CMX leadership team on segment priorities, emerging needs, and strategic opportunities — ensuring the department is always forward-looking in how it aligns resources and capabilities to business needs. • Develop and lead comprehensive enterprise-level acquisition marketing strategies across all business segments — individual, employer, Medicare, Medicaid, and ancillary health solutions — aligned to growth targets, brand positioning, and go-to-market priorities surfaced through segment engagement.

• Serve as the consistent, senior CMX presence in all segment leadership meetings, strategy sessions, and business planning forums — representing not just marketing, but the full Communications, Marketing & Customer Experience function. • Develop and maintain a deep, current understanding of each segment’s business strategy, competitive pressures, growth targets, operational challenges, and member or customer dynamics — well beyond what is needed to brief a campaign. • Listen to segment challenges with the breadth of the full CMX capability set in mind — identifying where marketing, communications, customer experience, brand, and insights each have a role to play, and framing integrated solutions rather than single-discipline responses. • Translate segment business needs into clear, actionable briefs for CMX subject matter experts — providing the strategic context, business rationale, and high-level direction that allows each SME to do their best work without needing to attend every segment conversation. • Mobilize and orchestrate the right CMX experts — across Communications, Customer Experience, Brand, Insights, and Marketing — for each segment challenge, ensuring the department delivers as one integrated function rather than a collection of independent capabilities. • Maintain a real-time understanding of priorities, capacity, and ongoing work across CMX disciplines, so that segment commitments are made with full awareness of what the department can deliver and when. • Serve as the accountability owner for CMX’s commitments to each segment — tracking deliverables, managing expectations, escalating risks, and ensuring the department consistently follows through on what it promises. • Build and sustain trusted, peer-level relationships with segment leaders in Commercial, Government, and Health Services — positioning CMX as a strategic partner that earns a seat at the table because of the value it creates, not because of its organizational role. • Proactively bring CMX insight, intelligence, and capability to segments before they ask — identifying opportunities where communications strategy, customer experience improvement, brand investment, or deeper audience insight could accelerate a segment’s goals, and making the case for that investment. • Report back to the VP, Enterprise Marketing & Acquisition and the broader CMX leadership team on segment priorities, emerging needs, and strategic opportunities — ensuring the department is always forward-looking in how it aligns resources and capabilities to business needs.

• Support the IT risk analysis function by setting direction and contributing to the information-gathering process, assessment of supporting technologies, and development of the audit program. • Collaborate with Audit team management and Staff members, as assigned, regarding audit program development. • Performs or directs staff performance of research on technologies included in the scope of audits, identifying assessment focus areas based upon risk analysis. • Performs or directs staff performance of key control testing through detailed analysis of various technical environments including operation systems, databases, network components and devices, and the related IT processes to manage those environments. • Communicates overall summary of audit results to management on a regular basis and alerts management to unusual or high-risk situations requiring immediate action. • Guides management in the development of satisfactory corrective actions in response to audit findings. Tracks progress against related corrective action plans, directing validation of key controls. • Develops and mentors systems audit staff.

• Monitor and interpret federal and state healthcare laws, regulations, regulatory guidance, and enforcement activities affecting GuideWell, its subsidiaries, and business operations. • Advise business units, operational leaders, and compliance functions on regulatory requirements, compliance obligations, and implementation strategies across the enterprise. • Develop, review, and update regulatory compliance policies, procedures, and guidance documents; ensure organizational policies reflect current regulatory requirements and best practices. • Provide legal analysis and counsel on healthcare regulatory matters including health insurance regulations, and managed care operations. • Conduct regulatory risk assessments for new products, services, business arrangements, and operational changes; advise on regulatory implications and mitigation strategies. • Coordinate with external counsel and consultants on complex regulatory matters; manage outside counsel relationships within budgetary parameters. • Support compliance program development and implementation to address federal and state regulatory requirements and mitigate regulatory risk. • Advise on regulatory aspects of contracts, partnerships, service agreements, and business transactions involving healthcare providers, vendors, and business partners. • Provide legal research, analysis, and written opinions on regulatory questions and emerging regulatory issues affecting the organization. • Prepare regulatory analysis and summary documents for Board committees, executive leadership, and business stakeholders on matters such as regulatory enforcement trends, legislative developments, and compliance priorities. • Participate in regulatory examinations, requests for information, and inquiries from state and federal regulators; coordinate appropriate organizational response. • Monitor healthcare industry regulatory trends, legislative developments, and enforcement priorities at federal and state levels; advise leadership on implications for organizational strategy and operations. • May assume additional legal responsibilities and special projects as needed to support organizational objectives and the broader legal department.

• Provide comprehensive legal counsel and advisory services to the Board of Directors and Board committees (Audit, Nominating & Governance, Compensation, and other governance committees) on governance frameworks, regulatory requirements, and risk management matters. • Develop, review, and update corporate governance policies, procedures, charters, and documentation to ensure compliance with applicable laws, regulations, and best practices; advise Board on governance trends. • Prepare and manage Board meeting materials including agendas, resolutions, minutes, consent agendas, and committee materials; ensure proper documentation, recordkeeping, and confidentiality of Board information. • Advise on Board composition, director qualifications, independence standards, conflicts of interest, related-party transactions, and Board committee structures and effectiveness. • Provide legal analysis and counsel on executive compensation arrangements, equity plans, director and officer indemnification, and D&O insurance matters. • Coordinate with external counsel, auditors, regulators, and other stakeholders regarding governance matters, regulatory examinations, and compliance inquiries. • Advise on corporate transactions, material contracts, and significant business arrangements involving governance, regulatory, or compliance considerations requiring Board awareness or approval. • Manage Board materials repository, governance documentation systems, and records management to ensure secure storage, version control, and appropriate access. • Conduct legal research and analysis; prepare written legal opinions, memoranda, presentations, and governance documentation for Board and leadership. • May assume additional legal responsibilities and special projects as needed to support organizational objectives and the broader legal department.

• Day-to-day processing of claims for accounts: • Responsible for processing of claims (medical, dental, vision, and mental health claims) • Claims processing and adjudication. • Claims research where applicable. • Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic). • Incumbents are expected to meet and/or exceed qualitative and quantitative production standards. • Investigation and overpayment administration: • Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers. • Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records. • Utilize systems to track complaints and resolutions. • Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading.

• Partner with senior executives and cross-functional teams to identify high-impact opportunities where behavioral science can advance core business priorities • Consult with stakeholders on business challenges, applying behavioral insights to improve decision-making, adoption, engagement, member experience, affordability, and health outcomes • Support enterprise transformation and change management efforts, including the adoption and ethical implementation of AI and emerging technologies • Develop frameworks and playbooks that make behavioral science accessible and actionable across the organization • Conduct literature review and analyze qualitative/quantitative data to uncover behavioral patterns, decision-making barriers, and opportunities for improvement • Design and lead experiments: randomized controlled trials, A/B tests, quasi-experimental studies, and field experiments • Develop behaviorally informed interventions including messaging and engagement strategies, incentive designs, and digital experience enhancements • Diagnose behavioral barriers to technology adoption and design solutions to improve uptake • Partner with product, analytics, operations, and business teams to implement, test, refine, and scale solutions • Own measurement and evaluation frameworks to assess impact and build the evidence base for what works • Build internal capability through workshops, presentations, practical frameworks, tools, and one-on-one consulting • Stay current on emerging behavioral science research and translate findings into enterprise applications • Represent the organization externally through conferences, publications, industry partnerships, and speaking engagements as appropriate

• The CMX Project Manager specializes in planning, managing, and executing project campaigns, and drives process excellence, continuous improvement, and operational efficiency across the CMX department. • Lead cross-functional project planning, execution, and delivery for high-visibility, strategic initiatives. • Create and manage project plans, including milestones and deadlines, tasks, responsible parties, and status updates. • Manage project campaign budgets and monitor progress through campaign completion. • Recommend strategies to increase campaign performance and process improvements. • Develop and maintain standardized operational processes, SOPs, and governance frameworks. • Develop and maintain CMX dashboards, KPI tracking, and performance reporting. • Collaborate with CMX leaders to improve coordination and reduce duplication.

• Provide strategic communications direction and tactical support as a practitioner, planner, and internal consultant focused on business units and/or functional areas. • Help drive and influence strategic thinking/direction of business leaders, partners and stakeholders regarding communications plans for program, product, service or capability launches, or enhancements. • Develop, implement, and measure the effectiveness of multifaceted, multi-audience integrated communication plans and tactics that support business-critical initiatives. • Integrate communication projects with other enterprise teams and take appropriate actions to partner with them. • Work collaboratively with Sr. Director Strategic Communications & Reputation/Sr. Director Enterprise Communications/Dir. of Internal Comms to continuously improve the communications function. • Demonstrate success in gaining leaders and internal business partner buy-in for strategic initiatives. • Own end-to-end development of integrated messages across multiple communication channels. • Provide broad communications support within the assigned pillar, assisting with editorial calendar management, content coordination, and project tracking. • Drive collaboration with communications colleagues and other enabling functions to ensure integrated planning and execution. • Track, analyze, and report on the performance of communications work to assess impact and inform future communications decisions.