4 Florida Blue Claims Analyst Jobs Hiring Near You

The successful candidate in this mid-level to senior level attorney position will provide comprehensive legal counsel on healthcare regulatory matters across the enterprise. With 8-12 years of relevant legal experience, this role requires advanced expertise in healthcare law, regulatory compliance, and government relations. The incumbent will serve as a primary advisor to business units and leadership on federal and state regulatory requirements, compliance risk management, and regulatory strategy. This position provides legal advice and counsel on complex regulatory assignments with minimal supervision and requires demonstrated leadership, independent judgment, and sound knowledge of the healthcare regulatory landscape.

• 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.

• Juris Doctorate degree from an accredited law school with a strong academic record and 10+ years of professional legal experience.
• Admission to at least one state bar. If bar admission is in a state other than Florida, then the ability to be certified in Florida as Authorized House Counsel.
• Comprehensive knowledge of federal and state healthcare regulatory framework including HIPAA, Health Insurance Portability and Accountability Act regulations, CMS rules and guidance, managed care regulations, and health plan operations requirements.
• Strong knowledge of state insurance laws and regulations governing health insurers, health plans, and managed care entities across multiple states.
• Demonstrated expertise in healthcare provider regulations, network adequacy standards, credentialing and peer review requirements, and other provider-related regulatory matters.
• Advanced knowledge of federal healthcare compliance programs and requirements including anti-kickback statutes, Stark law, fraud and abuse regulations, and False Claims Act implications.
• Demonstrated experience providing regulatory advice and counsel to healthcare organizations or business units on compliance and operational matters.
• Proven ability to analyze complex regulatory requirements and develop practical compliance solutions aligned with business objectives.
• Strong knowledge of healthcare industry operations, business models, and regulatory challenges affecting insurers, health plans, and integrated delivery systems.
• Excellent written and verbal communication skills with ability to translate complex regulatory concepts for non-attorney business audiences.

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.

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: $180,000 - $292,500

Typical Annualized Hiring Range: $180,000 - $225,000

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.