HealthFirst

Support Coordinator

HealthFirst · Full Time · 4 days ago

HealthFirst

🌎 United States 💵 $34900 - $54570 per year ⭐ 0-2 yrs exp 💼 Support

The Support Coordinator assists care managers with non-clinical activities, including managing authorizations, creating cases, and conducting telephonic outreach to members and providers. They are responsible for coordinating care, scheduling appointments, and ensuring accurate documentation in compliance with HIPAA regulations.

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Bilingual Sales Operations Service Agent (Mandarin/Cantonese

HealthFirst · Full Time · 5 days ago

HealthFirst

🌎 United States 💵 $42200 - $65960 per year ⭐ 2-5 yrs exp 💼 Sales

Provide high-quality telephone and written support to brokers, agents, and their uplines regarding eligibility, benefits, and commissions. Collaborate with management and quality assurance teams to resolve service-related projects and improve process trends.

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Appeals Specialist

HealthFirst · Full Time · 5 days ago

HealthFirst

🌎 United States 💵 $51000 - $80070 per year ⭐ 2-5 yrs exp 💼 Others

The Appeals Specialist is responsible for the end-to-end development and resolution of non-clinical member and provider appeals. This includes researching issues, interpreting regulations, and finalizing resolution letters within strict regulatory timeframes.

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Healthcare Claims, Data Engineer

HealthFirst · Full Time · 6 days ago

HealthFirst

🌎 United States 💵 $99100 - $156K per year ⭐ 5-10 yrs exp 💼 Software Development

The Data Engineer is responsible for designing and implementing data acquisition strategies, integration, and management procedures to support business requirements. This includes developing workflows, maintaining architectures, and deploying analytics programs to ensure data reliability and security.

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Care Coordinator

HealthFirst · Full Time · 8 days ago

HealthFirst

🌎 United States 💵 $42200 - $65960 per year ⭐ 2-5 yrs exp 💼 Healthcare

Perform care management services to help members navigate the healthcare system and handle incoming benefit and program inquiries. Manage a member caseload and collaborate with interdisciplinary teams to improve quality and cost outcomes.

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Appeals & Grievances Clinical Specialist

HealthFirst · Full Time · 8 days ago

HealthFirst

🌎 India, United States 💵 $73400 - $120K per year ⭐ 2-5 yrs exp 💼 Healthcare

The specialist is responsible for investigating and responding to clinical appeals and grievances from members and providers. This includes classifying cases, collaborating with other departments, and participating in regulatory site visits.

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Vendor Partner Specialist - Contact Center Operations

HealthFirst · Full Time · a month ago

HealthFirst

🌎 United States 💵 $51000 - $80070 per year ⭐ 2-5 yrs exp 💼 Support

The Vendor Partner Specialist manages relationships with external vendors to ensure service level agreement adherence and quality auditing. They act as a liaison between department leaders and vendors to coordinate workflow, training, and process improvements.

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CCO Service Agent – Language Requirement

HealthFirst · Full Time · 2 months ago

HealthFirst

🌎 United States 💵 $34900 - $54570 per year ⭐ 0-2 yrs exp 💼 Support

The Service Agent supports Contact Center Operations by addressing member and provider inquiries and resolving complaints across various lines of business. They are responsible for maintaining high customer experience standards, preventing dis-enrollments, and ensuring HIPAA compliance.

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Mgr Clinical Appeals and Grievances

HealthFirst · Full Time · 3 months ago

HealthFirst

🌎 India, United States 💵 $88700 - $149K per year ⭐ 5-10 yrs exp 💼 Healthcare

The Manager of Clinical Appeals and Grievances leads a team to standardize processes, ensure regulatory compliance, and optimize clinical appeal workflows. This role involves strategic decision-making, vendor oversight, and collaborating with leadership to meet production and quality targets.

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Medical Peer Reviewer

HealthFirst · Full Time · 4 months ago

HealthFirst

🌎 United States 💵 $122K - $188K per year ⭐ 2-5 yrs exp 💼 Healthcare

The Medical Peer Reviewer consults on medical necessity within utilization management, ensuring adherence to internal and external regulations by assessing authorization requests and claims payments based on medical records. This role involves rendering determinations within regulatory timeframes, maintaining productivity standards, and collaborating across various medical and management departments.

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Clinical Pharmacist, MTM - Bilingual Spanish

HealthFirst · Full Time · 6 months ago

HealthFirst

🌎 Albania, Argentina, Finland, Netherlands, United States 💵 $103K - $149K per year ⭐ 2-5 yrs exp 💼 Healthcare

The Clinical Pharmacist supports quality measures for Essential Plan and Medicare populations through provider and member outreach. They also ensure compliance with Federal and State regulations while collaborating with various internal teams.

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