Search the 20 jobs at Healthfirst, Inc

The Performance Support Specialist assists in resolving customer complaints, maintaining complaint tracking systems, and reaching out to members. They provide support to internal and external business partners, make recommendations for process improvements, and manage inquiries from various departments. This role requires excellent customer service skills and the ability to multitask efficiently.

The Support Coordinator assists care managers with non-clinical tasks such as case creation, managing authorizations, providing outreach, and handling member communication. They ensure compliance with requests, maintain documentation, and uphold HIPAA regulations while building relationships with members and providers.

The MuleSoft Application Developer is responsible for developing high-performing solutions using MuleSoft, implementing API-led connectivity, and collaborating within the Agile framework. Duties include configuring APIs, documenting solutions, conducting proof of concepts, and supporting existing architectures. A minimum of 3 years in MuleSoft development is required, alongside experience in SQL and CI/CD practices.

The HR Compliance Manager will oversee HR compliance programs, ensure adherence to federal and state regulations, manage audit responses, maintain compliance with EEO/AAP processes, and deliver training. Responsibilities include policy updates, collaboration across functional areas, and managing internal HR audits.

The Senior Manager of Marketing Analytics will lead a team to deliver reliable performance metrics and actionable insights from business data. Responsibilities include overseeing analytics programs, collaborating with business leaders, developing dashboards and reporting solutions, and engaging with IT for data analysis. The role requires strong programming skills and experience with various analytics tools and methods.

The Specialist will assist in executing and improving retail strategies for member and prospect experiences, manage day-to-day operations, support community engagement, and enhance operational standards through systems, processes, and training development. Responsibilities include coordinating with stakeholders, data collection, project management, and maintaining Salesforce for performance tracking.

The Lead Enterprise Architect provides strategic guidance in technology architecture to business domains, focusing on composable technology and capability-based planning. The role involves partnering with stakeholders, analyzing industry trends, coaching architects, and ensuring alignment with business strategies to drive organizational outcomes.

The Legal Contracting Specialist supports the Legal Department with the review and drafting of contracts, tracks healthcare agreements requiring regulatory approval, and assists with departmental projects. Responsibilities include ensuring compliance with policies, streamlining contract processes, effective communication with stakeholders, and providing administrative support.

The Principal Cloud Database Engineer is responsible for designing and implementing cloud-based database solutions, managing and optimizing cloud database instances, ensuring data security and compliance, monitoring and troubleshooting database issues, capacity planning, automation and scripting, collaboration and communication, continuous learning, and serving as a technical lead in the infrastructure team.

The Sr Operations Coding Analyst is responsible for making complex coding-based decisions on claims and appeals, maintaining claims editing systems, and providing guidance to junior analysts. They ensure claims payment accuracy, review and respond to provider correspondence, and collaborate with various departments to align payment policies. This position is remote and involves leading continuous improvement initiatives and mentoring team members.

The Manager, Enrollment & Billing oversees a defined line of business at Healthfirst, focusing on operational efficiency, accuracy, documentation, and reporting quality outcomes. Responsibilities include implementing policies and procedures, monitoring employee performance, managing team leads, resolving problems, and ensuring departmental goals are met. Additionally, responsible for reconciling Account Receivable variances and communicating with Finance Corp.

The Commission Analyst will be responsible for contract coordination of the appointment process for insurance producers marketing Healthfirst products. Responsibilities include oversight of appointment processes, review of credentialing paperwork, assistance with licensing issues, sales support, commission payments, and customer service for producers.

The Support Coordinator assists care/case managers with non-clinical activities, handles member inquiries, schedules appointments, and documents member information. Responsibilities also include managing a member caseload and improving quality outcomes.

The Manager of Actuarial Services at Healthfirst is responsible for monitoring the financial performance of the Medicare line of business, providing insights in business decisions, and conducting various actuarial functions. Duties include monitoring experience, supporting Medicare bids, analyzing market landscape, and managing staff.

The Support Coordinator assists care/case managers with non-clinical activities, handles member inquiries, documents member information, manages caseload, and escalates issues as needed. Responsible for telephonic outreach and administrative duties within a clinical team.

The Remote Case Manager - Utilization Management coordinates care plans for assigned members, conducts pre-certification, concurrent review, discharge planning, and case management. Ensures efficient utilization of health services, optimal outcomes, and meets quality metrics. Provides case management services, reports questionable healthcare services, and meets performance metric requirements. Acts as a clinical resource for the care team and identifies alternative care options based on member needs. Requires distinct healthcare licenses and preferred master's degree and relevant experience in managed care and case management.

Lead network optimization efforts by maximizing operational and reimbursement efficiency between Healthfirst and network partners. Develop and implement best practices for growth and optimization. Analyze data to identify payment integrity issues and solutions. Serve as an advocate for Hospital Providers within Healthfirst.

The Actuarial Analyst for Medicare will be responsible for actuarial analysis, pricing, forecasting, risk score analytics, data analysis, and reporting for Healthfirst's Medicare products. Duties include handling data for reports, performing analytics, assisting in bid processes, and monitoring product performance. Bachelor's degree in Actuarial Science or related fields is required, along with strong Excel skills, data analysis abilities, and communication skills.

The Senior Manager of Audit & Compliance Analytics leads analytics efforts to support Compliance and Internal Audit teams. This role develops strategies for high-priority analytics, manages stakeholder needs, oversees implementation of analytics solutions, and presents findings to various stakeholders, driving data-informed decision-making.

Healthfirst is seeking an HR Project Manager to lead and implement complex enterprise-wide projects, focusing on organizational development and leadership development. The role involves scoping, planning, and executing projects, managing stakeholders, and ensuring timely implementation. This is a hybrid position based in New York City.