Duties and Responsibilities:
- Analyze complex healthcare datasets to identify trends, anomalies, control gaps, and potential compliance or operational risks.
- Support Internal Audit, Compliance, and Claims Configuration Audit activities through data analysis, audit testing, monitoring, and reporting.
- Develop advanced SQL, SAS, or other analytical queries to extract, validate, and analyze data from multiple sources.
- Evaluate data quality and standardize data structures to support consistent reporting and analysis.
- Create and maintain dashboards, scorecards, reports, and monitoring tools that provide actionable insights to leadership and business stakeholders.
- Summarize findings, methodologies, and recommendations for technical and non-technical audiences.
- Assist in the validation of claims configuration changes, business rules, and operational controls.
- Document analytical processes, data issues, methodologies, and business requirements.
- Collaborate with Internal Audit, Compliance, Claims Operations, Configuration, IT, and other business partners.
- Demonstrate intellectual curiosity and identify opportunities for process, control, and reporting improvements.
- Additional duties as assigned.
Minimum Qualifications:
- Bachelor’s degree from an accredited institution or equivalent work experience
- 3+ years of equivalent experience
- Proficiency in scripting and programming skills
- Experience using MS Office suite, including Microsoft Access, Excel, and Word
- Expertise in utilizing data analysis and query tools such as SQL
- Experience with Alteryx, Tableau, Amazon Redshift, or other similar tools/platforms
- Experience with applied statistics skills, such as distributions, statistical testing, regression, etc.
- Ability to successfully run queries from a data warehouse
- Expertise innovating and implementing audit techniques
- Excellent communication skills
- Excellent time management and the ability to prioritize work and complete assignments within their allotted deadline
- Experience working with and communicating technical information to multiple levels of technical and non-technical staff in written and verbal form
- Experience prioritizing a heavy workload in a fast-paced environment
Preferred Qualifications:
- Master’s degree from an accredited institution
- Degree in Mathematics, Computer Science, Data Sciences, Engineering, Business Analytics, Informatics, or similar concentration
- Experience with analytical programming techniques such as Python and R
- Experience with AWS and analytical solutions available on the platform (Redshift, Glue, Sage Maker, etc.)
- Familiarity with programming in JavaScript, D3.js
- Familiarity with big data technologies, such as Hadoop, MapReduce, and AWS Kinesis
- Demonstrated ability to develop innovative solutions to complex problems, leveraging advanced problem-solving skills and sound judgment to make critical, independent decisions within area of responsibility
- Knowledge of modern machine learning algorithms (clustering, classification and regression), statistical methods and optimization
- Knowledge of health care industry, systems, business strategies and products
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC.
Know Your Rights
All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
Hiring Range*:
Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360
All Other Locations (within approved locations): $73,400 - $109,225
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.
Skills Required
- Bachelor's degree or equivalent work experience
- 3+ years of equivalent experience
- Proficiency in scripting and programming skills
- Experience using Microsoft Access, Excel, and Word
- Expertise in SQL and ability to run queries from a data warehouse
- Experience with SAS and developing advanced analytical queries
- Experience with Alteryx, Tableau, or Amazon Redshift
- Applied statistics skills (distributions, statistical testing, regression)
- Expertise innovating and implementing audit techniques
- Excellent written and verbal communication skills
- Strong time management and ability to prioritize heavy workload
- Experience communicating technical information to technical and non-technical staff
- Ability to document analytical processes, methodologies, and business requirements
- Master's degree
- Degree in Mathematics, Computer Science, Data Sciences, Engineering, Business Analytics, Informatics, or similar
- Experience with Python and R
- Experience with AWS analytical solutions (Redshift, Glue, SageMaker)
- Familiarity with JavaScript and D3.js
- Familiarity with big data technologies (Hadoop, MapReduce) and AWS Kinesis
- Knowledge of modern machine learning algorithms, statistical methods, and optimization
- Knowledge of health care industry, systems, business strategies and products
Healthfirst, Inc Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Healthfirst, Inc and has not been reviewed or approved by Healthfirst, Inc.
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Healthcare Strength — Healthcare coverage is positioned as a comprehensive offering, including medical/dental/vision options and additional mental-health support through Spring Health. Wellness credits and disability coverage further strengthen the perceived breadth of health-related support.
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Leave & Time Off Breadth — Time off appears robust, with paid time off plus a set of paid holidays and additional early office-closure days. A designated Social Justice day and noted parental/bereavement leave options add to the overall leave breadth.
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Retirement Support — Retirement support is framed around a 401(k) program with a company match that can reach a meaningful level after a tenure milestone. This match is repeatedly highlighted as a notable component of total rewards value.
Healthfirst, Inc Insights
What We Do
Healthfirst is a provider-sponsored health insurance company that serves 1.8 million members in downstate New York. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals. For more information on Healthfirst, visit www.healthfirst.org
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