Responsible for conducting quality audits of financial processes, coaching junior auditors, analyzing errors, and preparing reports to ensure compliance and mitigate risks.

The Manager, Claims Modernization will lead data-driven analytics initiatives, improve data quality, oversee reporting projects, and enhance operational efficiency through process improvement collaborations with stakeholders.

The Scrum Master manages enterprise-level programs, facilitates communication, removes blockers, and supports both the Product Owner and Scrum Team by coaching and managing Scrum practices.

The Data Platform Architect will lead the design and implementation of a scalable Data Lakehouse on AWS, integrate storage and compute solutions, ensure performance optimization, and collaborate with stakeholders while mentoring junior staff.

The Program Coordinator supports Healthfirst initiatives related to Member Rewards, conducts outreach, tracks implementation status, communicates findings, and assists in updating materials.

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

The Director of Utilization Management leads strategic oversight for UM teams, ensuring quality care and compliance with regulatory standards while driving process improvement and innovation.

The Senior Product Strategy Specialist leads product initiatives for Medicaid Products, coordinating with cross-functional teams, ensuring accurate documentation, and driving strategic execution.

The Sales Support Associate coordinates enrollment events and collaborates with Sales Managers to promote Healthfirst’s services, supporting membership growth and retention through community outreach and marketing.

The Ancillary Services Network Account Manager I develops and maintains a provider network while ensuring quality care, managing claims issues, and facilitating provider education.

The Grievance Specialist manages grievances and complaints, ensuring timely resolution per regulatory standards, while collaborating cross-functionally and with external vendors.

The Risk Score Accuracy Manager will oversee analytics related to risk score forecasting and manage regulatory audit processes, requiring SQL proficiency and cross-department collaboration.

The Appeals Specialist processes member and provider appeals, conducts case development, ensures compliance with regulations, and resolves disputes within timeframes.

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.

The Finance Operations Analyst handles finance operations functions, including payment processing, reconciliation, reporting, and analysis of claims and refunds.