Jobs at Healthfirst, Inc

Architects scalable, secure, compliant, and cost-conscious enterprise infrastructure and AI platforms. Defines AWS-first reference architectures, platform engineering patterns, governance, observability, integration, security, and operational guardrails. Evaluates emerging AI and automation technologies, validates designs through proofs of concept, partners with engineering and IT stakeholders, and guides platform implementation and handoff in a regulated healthcare environment.

Leads product management and market growth strategy across a Medicaid and Medicare portfolio. Responsibilities include executive presentations, operating reviews, KPI tracking, competitive intelligence, membership growth and retention planning, operational efficiency, portfolio insights, and profit-and-loss accountability. The role partners cross-functionally with finance, sales, marketing, and other departments while managing strategic projects and reporting metrics.

Leads the design and development of multimodal synchronous and asynchronous learning programs. Partners with stakeholders and subject matter experts to define objectives, create courseware and multimedia assets, measure outcomes, manage vendors, and improve learning effectiveness. Provides mentorship, establishes instructional standards, supports business transformation, and oversees complex learning projects aligned with organizational strategy and culture.

Manages Healthfirst’s ancillary provider network across Medicaid, Medicare, Commercial, and CHP lines of business. Responsibilities include provider recruitment, contracting, credentialing review, reimbursement negotiations, network audits, claims issue resolution, provider education, appeals liaison work, and compliance with health plan network requirements. The role collaborates with network management, credentialing, analytics, reimbursement, claims, and appeals teams while addressing provider inquiries and supporting implementation projects.

Leads delivery of Healthfirst data platforms, applications, pipelines, and capabilities while managing two Agile teams. Translates business requirements into features, oversees planning through production support, and partners with architecture, governance, IT, and stakeholders. Ensures scalable AWS-based solutions, data quality, security, regulatory reporting readiness, incident resolution, and modernization. Mentors multidisciplinary teams and drives operational discipline, reusable patterns, pipeline reliability, and reduction of legacy-tool dependencies.

The Senior Business Analyst supports Provider Data Operations through business process review, data analysis, reporting, testing, workflow improvement, and project coordination. The role develops and maintains statistical reports, identifies defects and operational improvements, validates business requirements, supports testing and implementation, and guides junior analysts. It also ensures compliance with regulatory and corporate requirements while communicating analytical findings and recommendations to management and cross-functional teams.

The job description contains no specific responsibilities or qualification details for the Director of Business Contracting role.

Owns the architecture, integration, interoperability, monitoring, and reliability of Healthfirst’s HR technology ecosystem. The role designs Workday and vendor-system integrations, improves workflows and data integrity, resolves complex system issues, establishes governance and documentation, coordinates technical vendors, and partners with data teams. It also leads and develops a small HR Technology team while reducing manual work, operational demand, and dependence on IT and consultants.

Supports care and case managers with non-clinical coordination, authorization management, member and provider outreach, case documentation, mailings, faxing, scheduling, and issue escalation. Handles high-volume queues while maintaining quality, productivity, HIPAA compliance, and confidentiality. Provides customer service, updates member information, communicates care needs, and coordinates with internal teams, providers, and community organizations. Spanish fluency is preferred, along with healthcare, managed care, medical terminology, and CRM experience.

Manage claims-related modernization initiatives, oversee project reports, collaborate with IT, and implement process improvements in a healthcare setting.

Build and manage relationships with community organizations to connect New Yorkers to health-insurance resources. Plan and execute community events, track partnerships in Salesforce, report outcomes to leadership, evaluate engagement effectiveness, and support community members seeking assistance.

Perform routine and risk-based audits of claims configuration and provider reimbursement across lines of business. Validate claim outcomes against contracts and regulations, identify defects and financial impact, analyze data for trends/root causes, prepare workpapers and reports, coordinate remediation and retesting, and act as subject-matter resource for claims configuration and quality.

Lead strategy and operations for provider payment configuration, ensuring accurate reimbursement rates, benefits configuration, provider onboarding, credentialing, and provider database maintenance. Oversee testing, controls, regulatory compliance, and cross-functional alignment. Build and manage a team, improve provider payment experience, and support stakeholder requirements and audits.

The Peer Support Specialist supports members with mental health and substance use issues, coordinating care and linking them to resources while modeling recovery through lived experience.

Provide peer-based recovery support to members with mental health or substance use disorders via field visits and phone outreach. Manage caseloads, complete assessments, coordinate care and referrals, document encounters, liaise with providers and interdisciplinary teams, and assist with navigation and linkage to community resources.

Lead strategic engagement and high-stakes negotiations to convert out-of-network providers to in-network, secure competitive reimbursement rates, and improve network adequacy. Use market intelligence and utilization analytics to structure contracts, align with finance and legal, and ensure smooth onboarding. Track and report measurable outcomes, provide executive reporting, and serve as a subject-matter expert on reimbursement methodologies and provider market dynamics.

The Senior Specialist coordinates product initiatives by collaborating with cross-functional teams, managing project schedules, and analyzing market trends while supporting senior management.

Lead forecasting quality, capacity planning, and performance oversight for a multichannel contact center and BPO partners. Own end-to-end forecasting, translate demand into staffing plans, monitor KPIs, develop and refine models (using Verint), create SOPs, and provide data-driven insights to leadership to improve accuracy and operational outcomes.

The AVP of Community Engagement leads Healthfirst's community health initiatives, driving partnerships, enrollment, and retention strategies to enhance member health and improve community well-being.