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Finance Operations Analyst

NY Req ID: R021335 Hybrid
This is a Hybrid-NY role, located at 100 Church Street, requiring three days per week in the office (Tues//Wed//Thurs).Scope of Responsibilities:Create service forms for returned checks and vendor refunds in PEGA.Process Medical Home, Member Refund, FQHC, and other ad-hoc transactions in...
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QA Auditor II - Remote

NY Req ID: R021225 Remote
This position is 100% Remote. Scope of Responsibilities:Conduct moderately complex to complex quality audits of provider claims, pre-payments and post-payments including high-dollar and specialized claims across multiple lines of business, claim types and products.Audit the work of more...
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Director Utilization Management

NY Req ID: R021231 Hybrid
Duties/Responsibilities:Provide strategic direction and leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requestsDevelop strong operational and leadership capabilities within the organization through performance...
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Manager, Risk Score Accuracy

NY Req ID: R021230 Hybrid
Who we are:Healthfirst was founded by a collection of major healthcare systems in the New York area to emphasize high quality of care, and better patient outcomes. We have grown into New York’s largest not-for-profit health insurer that covers members in New York City and on Long Island, as well...
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Instructional Designer

NY Req ID: R021200 Remote
Scope of Responsibilities:Partner with senior instructional designer or other learning leader to identify learning objectives, gather requirements, define outcomes, and establish evaluation measures and success metrics.Engage in a collaborative development process ensuring to partner with SME’s,...
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UM Pharmacy Technician-1

NY Req ID: R021182 Remote
Duties & Responsibilities:Reviews prior authorization requests and units for medications requested under the medical benefitAssesses provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteriaSends notification to members and providers of...
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Grievance Specialist

FL Req ID: R021350 Remote
Key Responsibilities:Independently manage a caseload of grievances through the full case lifecycle, from written acknowledgement to investigation, resolution, and written member resolution letters.Conduct detailed research by collaborating cross-functionally with internal departments (e.g.,...
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