140 jobs

The Sr. Scrum Master/Sr. Project Manager oversees broad scope company projects and manages medium to large enterprise-level projects that have department or enterprise-level importance, moderate to high risk and risk interdependencies, several interrelationships, and moderate to high costs associate ...

The Claims Implementation Analyst is responsible for assisting in analyzing, implementing and reporting of required claims configuration business rules. The Implementation Analyst will assist management by developing and maintaining reporting tool and processes, querying and analyzing data, identify ...

The Support Coordinator is responsible for assisting the care/case managers with non-clinical activities such as creating cases and events; providing telephonic outreach to members, providers and community-based organizations; handling member mailings; faxing clinical requests and Individual Health ...

The Medical Economics Analyst (MEA) provides support to the Medical Economics team within Finance through the research and investigation of business issues related to cost, utilization and revenue for multiple Healthfirst products. The MEA will identify/monitor cost and utilization trends and the ro ...

The Senior Analyst will be providing analytical support to the Medicare Product Strategy and Management team to develop, assist in execution, and continuously improve upon a market growth strategy that supports a profitable growth across the entire Medicare Advantage portfolio. Duties and Responsibi ...

The Medical Economics Analyst (MEA) provides support to the Medical Economics team within Finance through the research and investigation of business issues related to cost, utilization and revenue for multiple Healthfirst products. The MEA will identify/monitor cost and utilization trends and the ro ...

The Director, Clinical Vendor Management Oversight is the single point of contact for all delegated medical vendor related compliance and regulatory activities and is responsible for ensuring compliance with all legal and regulatory guidelines. This position will serve as the liaison for Regulatory ...

• The Change Management Specialist will play an integral role in the success of the business transformation group in ensuring projects (change initiatives) meet objectives on time and on budget and that adoption is optimal to drive benefit realization. • This person will focus on the people side of ...

The Senior Provider Advocate (SPA) is responsible for the full range investigation, reporting and summarizing of end-to-end claims processing. The incumbent will nurture positive relationships between the health plan, Providers (physician, hospital, ancillary, etc.) and practice managers. Work withi ...

The Coding Educator is responsible for overseeing and educating providers on the proper use of diagnosis coding to ensure CMS and ICD10 CM guidelines are followed to substantiate the Risk Adjustment HCCs that are reported by providers. Also responsible for auditing clinical documentation encounters ...

The Senior Claims Examiner is responsible for the investigation, determination and reporting of claims processing thru auditing of normal business processes as well as handling second level appeal requests. The incumbent will audit, conduct root cause analysis, handle processing of determinations, t ...

The Marketing Specialist II contribute ideas for identifying new referral sources, as well as, identify referral sources within their territory of responsibility whose mission and needs are focused on the frail adult and their Managed Long|Term Care (MLTCP) / Medicaid Advantage Plus (MAP) needs. The ...

The Care Manager plans and manages behavioral and/or physical care with members and their beneficiaries and works with clinicians and health care team members. The Care Manager facilitates care and medical attention and addresses identified member needs across the continuum of care. The Care Manager ...

The Medicare Sales Specialist is a position for top performing Medicare Sales Agents in the NY market. The individual is responsible for identifying prospective Medicare Advantage (MA) beneficiaries, self- generating leads, educating and enrolling beneficiaries in the appropriate MA plan by explaini ...

The Field Service Agent acts as an in-person liaison between Healthfirst and its customers. The individual is responsible for assisting customers with issues and inquiries they may have about their insurance, applications and/or claims not paid. The Field Service Agent is also responsible for receiv ...

Interested in bringing your Salesforce Development experience to a company and industry that matters? The Salesforce Developer's primary responsibilities are to analyze, design, implement and test customized software applications. They should have essential knowledge of software development and desi ...

The Healthcare Economics Analyst (HEA) provides support to the Medical Economics team within Finance through the research and investigation of business issues related to cost, utilization and revenue data for multiple Healthfirst products. The HEA will identify/monitor cost and utilization trends an ...

The Field Service Agent acts as an in-person liaison between Healthfirst and its customers. The individual is responsible for assisting customers with issues and inquiries they may have about their insurance, applications and/or claims not paid. The Field Service Agent is also responsible for receiv ...

The Product Owner will help create and deliver a best-in-class business systems and operational processes. This individual will be dedicated to the Agile Work Team to interface between the operations team and the delivery of new technology and code. The role is responsible to be constantly thinking ...

The Marketing Representative| Medicare Sales, maintains relationships, services our existing customers and secures new customers by consultative selling/marketing and performing all required tasks assigned by the Sales Manager. S/he isresponsible for educating and enrolling potential beneficiaries b ...