Jobs at Healthfirst, Inc

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.

The AVP of Community Engagement leads strategies to enhance community health, improve member health outcomes, and operationalize initiatives aligning with marketing and enterprise objectives. Responsibilities include managing a team, executing community strategies, tracking outcomes, and building partnerships with local organizations.

Analyze financial performance and utilization for Healthfirst products, identify trends and root causes, build financial and reimbursement models, perform ad hoc and ROI analyses, support medical cost reduction projects, and collaborate with stakeholders across Finance, Network, IT, and provider networks to inform decisions and track impacts of Medicaid/Medicare reforms.

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.

The Senior Manager, HRBP-IT leads HR initiatives within the IT department, aligning people strategies with business goals while focusing on talent management and change during digital transformation.

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.

Manage and develop an Ancillary provider network ensuring Healthfirst members receive quality care while resolving claims issues and facilitating provider education.

Front-line community office coordinator who greets and triages members, registers and educates on the member portal, audits applications, tracks office metrics, manages inventory/mail/calendar duties, escalates member and sales issues, conducts representative training, and ensures privacy/PHI protection while supporting office opening/closing and reporting.

The Director of Performance Improvement leads initiatives to enhance business processes and productivity, manages staff, and collaborates on strategy development.

The Coding Educator trains providers on diagnosis coding compliance, audits clinical documentation, manages inquiries, and develops educational materials to improve coding accuracy.

The Senior Social Media Manager will strategize and execute social media campaigns, analyze data, manage content development, and lead a team to enhance brand engagement.

The Senior Product Specialist leads initiatives, collaborating with teams to enhance products within the Healthfirst portfolio while managing project execution and communication across departments.

The Manager, Enrollment & Billing oversees billing and enrollment processes, ensures operational efficiency, manages team performance, and implements improvements. They collaborate across departments to maintain data integrity and meet deadlines.

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

Lead enterprise data ownership and governance to align customer experience with information architecture. Develop data usage frameworks, business rules, quality thresholds, and movement authorizations. Direct data stewards, analysts, and architects; prioritize remediation, support data integration and analytics, and guide development of data warehouse, data marts, and reporting solutions to support healthcare enrollment and billing operations.

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 Product Owner will drive product strategy and execution within an Agile environment, coordinating between operations and technology teams to enhance business processes and customer satisfaction.

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.