Browse current Healthfirst openings that JobDrop found directly from the company's careers source.
The Sales Operations Service Agent is responsible for supporting the Sales Operations Service Center by ensuring that brokers/agents and their uplines receive exceptional customer service. The Sales Operations Service Agent fields phone and written inquiries from Brokers/ Agents and their uplines. The Sales Operations
The Procurement Intelligence Analyst develops and delivers the analytics, market intelligence, performance reporting, and data insights that enable Enterprise Procurement to make informed, data-driven decisions. The role transforms procurement, supplier, financial, and operational data into actionable insights supporti
The Vendor Lead is responsible for strengthening vendor performance, governance, risk management, and strategic relationships across an assigned portfolio of enterprise vendors. The role operates through a combination of center-led vendor governance and centralized vendor management, applying the appropriate level of o
The Data Engineer is responsible for data acquisition strategies and integration, scripting and tools, data migrations, conversions, purging, and back-ups. The incumbent works with product, financial control, analysts, users, and other stakeholders to understand business requirements and support data architecture to bu
The Learning Delivery Specialist (Clinical RN) will act as an ambassador in fostering the HF culture and supporting the implementation and delivery of content relevant to enterprise initiatives, business units and strategy. This individual will lead and support learning projects and will be responsible for researching,
The Manager, Behavioral Health Utilization Management and Applied Behavior Analysis (ABA) Peer Reviewer provides clinical leadership and operational oversight for Behavioral Health Utilization Management (BH UM) and ABA services. The Manager supervises and supports clinical review activities across the behavioral healt
The Sr ServiceNow Developer will play a key role in maturing our ServiceNow platform, and as a result, our Service Management practice. This individual will be working with key business units and process managers in order to build solutions and processes, supporting maintenance, continual service improvement, and new c
A Category Manager for IT Hardware, Software, and Telecommunications develops and executes enterprise category strategies that optimize value, manage risk, and enable business growth through data-driven decision-making, digital procurement capabilities, and strategic supplier partnerships. Working collaboratively acros
The Senior Manager – Head of Procurement Center of Excellence (COE) provides strategic leadership for Enterprise Procurement's governance, digital procurement, analytics, process excellence, vendor management governance, and organizational capability functions. The role is responsible for developing the standards, meth
The Strategic Sourcing Specialist executes enterprise strategic sourcing initiatives across multiple spend categories, translating category sourcing strategies into disciplined, competitive sourcing events that deliver measurable commercial value. The role manages RFx execution, supplier engagement, proposal analysis,
The Procurement Digital Transformation Lead develops and executes the digital procurement roadmap that enables Enterprise Procurement to operate as a scalable, data-driven, and AI-enabled function. The role is responsible for translating procurement strategy and operating-model requirements into technology, automation,
The Category Manager – Services develops and executes enterprise category strategies that optimize value, manage risk, and enable business growth through data-driven decision-making, digital procurement capabilities, and strategic supplier partnerships. Working collaboratively across Procurement COE, Operations, Financ
The Clinical Quality Project Coordinator is responsible for coordinating medical record retrieval activities, including in-person retrievals at provider offices and healthcare facilities. Responsibilities include submitting and tracking record requests, monitoring and following up on outstanding requests, performing qu
Care Coordinators are responsible for performing care management services in order to support members who require assistance in navigating their health care system. The Care Coordinator is aligned to a Care Management team or a call center. Duties and Responsibilities: - For Call Center: Receive Incoming calls from mem
The Healthfirst Credentialing department credentials and re-credentials providers, facilities and vendors; prepares hard-copy directories and reviews network provider data for accuracy and ensures compliance with regulatory requirements and federal and state regulations. - Credentials providers, facilities, and vendors
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 receiving and addressing m
As a valued member of the Behavioral Health Care Management Team, the Peer Support Specialist (PSS) utilizes lived experience to model recovery and support Healthfirst members who are struggling with mental health and/or substance use disorders. The PSS works directly with members in both field-based settings and telep
The Clinical Coding Retrieval Coordinator is responsible for supporting Healthfirst initiatives and regulatory requirements related to RADV medical records acquisition. This position is provider facing. This position has a hybrid work location: Remote, office based, and in the field as needed. Office location is 100 Ch
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 Care Plans on behalf
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 Care Plans on behalf
The Field Service Agent acts as an in-person liaison between Healthfirst and its customers. This individual receives and addresses member & provider inquiries, de-escalates and resolves complaints, educates clients, engages in member retention activities, and escalates issues requiring additional intervention across al
The Senior Healthcare Analyst provides support through the research and investigation of business issues related to cost, utilization, and revenue data for multiple Healthfirst products. The HCA will identify/monitor cost and utilization trends and the root causes in health plan trend performance and provide recommenda
Summary: • The Staff Accountant in Healthfirst's Finance department is primarily responsible for preparing monthly journal entries for all Revenue and Expenses. • The Staff Accountant will also be responsible for ensuring that there is efficient external support for the journal entries. • Additional responsibility also
Healthfirst is New York City’s largest not-for-profit health insurer, dedicated to improving health through community-driven, value-based care. For over 30 years, we have led the shift from volume to value by focusing on better outcomes, preventative care, and cost efficiency. Recognized by Forbes as a Dream Employer o
The Clinical Quality Manager works with members and providers to ensure members receive appropriate services. This role emphasizes improving the quality of care with a focus on HEDIS, QARR and Medicare Advantage Star measures. Duties & Responsibilities: - Interacts with hospitals, providers, and members to improve qual
The Process Manager for Enrollment and Billing (E&B) leads the execution of processes that support the delivery of critical health services for Healthfirst customers. The incumbent monitors, reports, and plans for improvement across a set of core operational processes. The process manager oversees and optimizes the dai
The Fleet Driver is responsible for maintaining an efficient, well organized community outreach vehicle (COV) and cargo van at the assigned Healthfirst marketing location. The Driver is accountable for the day to day operations on the assigned COV/cargo van, liable for all marketing materials on the assigned RV, the or
The AI Infrastructure Architect role at Healthfirst works to establish sustainable design principles across infrastructure systems, cloud platforms, enterprise integration patterns, and emerging AI platform capabilities. This person will work internally across Infrastructure & Operations (I&O), as well as externally wi
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 infor
Under the direction of the Manager of Ancillary Services, the Ancillary Services Contractor develops and maintains an Ancillary provider network that ensures Healthfirst members have superior access to the highest quality by focusing efforts on lowering claims costs, improving the quality of care, and increasing member
We are seeking a Cyber Security Engineer – Data Security to design, implement, and continuously improve security capabilities that protect sensitive data across the enterprise. This is a hands-on security engineering role focused on understanding where sensitive data resides, how it moves, who and what can access it, a
The Appeals & Grievances (A&G) Weekend Inventory Manager is responsible for managing and monitoring appeal inventory for a team of A&G Clinical Specialist. This is a full-time role, expected to work 4 days a week and must be able to work the weekends (i.e. Fri-Mon or Thurs-Sun). The incumbent works closely with multipl
>Healthfirst is New York City’s largest not-for-profit health insurer, dedicated to improving health through community-driven, value-based care. For over 30 years, we have led the shift from volume to value by focusing on better outcomes, preventative care, and cost efficiency. Recognized by Forbes as a Dream Employer
The Field Service Agent acts as an in-person liaison between Healthfirst and its customers. This individual receives and addresses member & provider inquiries, de-escalates and resolves complaints, educates clients, engages in member retention activities, and escalates issues requiring additional intervention across al
The Hospital Specialist is the point person responsible for ensuring maximization of operational efficiency between Healthfirst and our network hospitals. This role is required to report onsite to our 100 Church Street office Tuesday-Thursday. Responsibilities: - Managing day to day operational issues and concerns from
Care Coordinators are responsible for performing care management services in order to support members who require assistance in navigating their health care system. The Care Coordinator supports various teams to provide excellent customer service to our NorthStar Members. Duties and Responsibilities: - Receive incoming
As a Software Production Support Lead, you will ensure the stability, availability, and performance of our products. You will collaborate with cross-functional teams to investigate complex technical issues, support users, and contribute to the continuous improvement of our processes. Duties & Responsibilities: - Review
The Entitlement Advocate provides Healthfirst’s Medicare Advantage Plan(MAP), Managed Long-Term Care Plan(LTC), Dual eligible Medicare Plan and Nursing Home members and prospects with obtaining and retaining of financial entitlements for which they are eligible. This enables prospects and members to maintain the highes
The Clinical Quality Specialist is responsible for performing Healthcare Effectiveness Data and Information Set (HEDIS) medical record review, supplemental data validation, data abstraction, and clinical data quality activities using internal and external clinical data sources. This role supports the accurate, timely,
The Manager, Medicare Digital Growth and Lead Management — Digital Sales Growth & Enterprise Lead Management - will help establish, grow, and optimize Healthfirst’s Medicare Digital sales channel while advancing enterprise lead management strategy across Medicare distribution channels. The Manager will be responsible f
The Manager, Total Cost of Care, will monitor financial performance and provide analytic insights into all products offered within the Healthfirst portfolio. This leader will serve as healthcare economics and analytics subject matter expert, across all areas of medical trend, medical cost savings, provider network info
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 infor
The Senior Manager, Clinical Appeals & Grievances provides strategic and operational leadership for the Clinical Appeals & Grievances function, ensuring timely, high-quality, and compliant review of clinical appeals and/or grievance cases. This role oversees day-to-day operations, leads internal teams, and partners wit
The Sr AI Security Engineer continuously monitors the vulnerability of the enterprise and develops engineering solutions to improve the security of the Healthfirst infrastructure. The Sr AI Security Engineer applies expertise across the Cyber Security discipline by demonstrating competency in IT Infrastructure and Appl
Job Profile Summary The Support Coordinator is responsible for assisting the care/case managers with non-clinical activities such as creating cases and events; managing authorizations; providing telephonic outreach to members, providers and community-based organizations; handling member mailings; faxing clinical reques
Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. A&G works in collaboration with divisions within and outside the organiza
The Workforce Enablement Senior Forecast Planning Analyst is responsible for leading forecasting quality, capacity planning, and performance oversight across a multichannel contact center environment, including internal operations and Business Process Outsourcing (BPO) partners. This role ensures the accuracy, consiste
Community Relations Specialists are on the front lines of improving the lives of New Yorkers by connecting people to health-insurance products and resources that create greater health equity. Community Relations Specialists are bridge-builders, connecting communities to needed information that empowers them to live hea
The Field Service Agent acts as an in-person liaison between Healthfirst and its customers. This individual receives and addresses member & provider inquiries, de-escalates and resolves complaints, educates clients, engages in member retention activities, and escalates issues requiring additional intervention across al
The Senior Analyst, Audit and Compliance Analytics leverages healthcare data, analytical tools, and business knowledge to support Internal Audit, Compliance Analytics, and Claims Configuration Audit initiatives. This role partners with cross-functional teams to identify risks, evaluate controls, analyze claims and conf
The Assistant Vice President (AVP) of Provider Payment partners with senior leadership to design and implement the methods and procedures essential for successful claim & benefit configuration, provider onboarding, and maintenance of provider records. The incumbent provides strategic leadership and oversight to establi
The Configuration Analyst of Office365 is responsible for managing, administering and governing the Office 365 global tenants, including SharePoint Online, MS Teams, OneDrive and other applications within the Office365 suite. The resource will work in a dedicated team focused on enterprise collaboration. Candidate must
The Senior Mgr of Clinical Eligibility will have knowledge of the current assessment process, for both Medicaid and Medicare programs. This position will support the Assessment Managers in planning, directing, and implementing processes for successful outcomes and achieving goals. The Sr Mgr conducts and contributes to
The Vendor Partner Specialist is the principal contact for all vendor-related interdepartmental collaborations and is responsible for the relationship and management of business services being performed by external vendors (including off-shore). Management of these services will include, but not be limited to, service
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 infor
The Senior Analyst, Total Cost of Care, will develop analyses and tools to help monitor financial performance and provide analytic insights into all products offered within the Healthfirst portfolio. This key role will serve as healthcare analytics and data subject matter expert, supporting all areas of medical trend,
The Clinical Pharmacist is responsible for efforts to support quality measures for both our Essential Plan and Medicare populations. The Clinical Pharmacist conducts provider and member outreach to address gaps in care measures, support medication adherence initiatives, and assist with strategies to improve quality mea
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 infor
The UM Pharmacy Technician is responsible for the intake and review of prior authorization requests for medications requested under the medical benefit. The UM Pharmacy Technician makes approval decisions and denial recommendations based on predetermined clinical criteria. They establish rapport with Provider offices a
Healthfirst is New York City’s largest not-for-profit health insurer, dedicated to improving health through community-driven, value-based care. For over 30 years, we have led the shift from volume to value by focusing on better outcomes, preventative care, and cost efficiency. Recognized by Forbes as a Dream Employer o