Jobs at Healthfirst, Inc

Analyze complex healthcare datasets to support Internal Audit, Compliance, and Claims Configuration Audit. Develop SQL/SAS queries, validate data and claims configurations, build dashboards and reports, identify risks and control gaps, document methodologies, and collaborate cross-functionally to improve controls and payment accuracy.

The Product Owner will drive product strategy and execution within an Agile environment, coordinating between operations and technology teams to enhance business processes and customer satisfaction.

The AVP of Community Engagement leads Healthfirst's community health initiatives, driving partnerships, enrollment, and retention strategies to enhance member health and improve community well-being.

Lead enterprise process architecture for AI-enabled workflows: establish decomposition methods, standards, reusable process modules, human-agent patterns, governance, and partner with delivery teams to ensure scalable, observable, compliant, and optimizable process designs that meet business and customer outcomes.

Lead enterprise information architecture by defining and executing the information management and enterprise data architecture roadmaps. Partner with business and IT stakeholders to design data models, integrate data stores/EDW/ODS, enable analytics and BI, and drive governance, data integration, and deployment practices. Mentor teams, influence cross-functional decisions, and support transformation efforts aligning data assets with corporate strategy.

Lead development and execution of Medicaid member experience strategy, driving journey design, personalization, segmentation, and engagement. Partner cross-functionally to translate insights and VOC into roadmaps, manage a portfolio of initiatives, define metrics, and lead a small strategy team to improve member engagement, satisfaction, retention, and outcomes within regulatory constraints.

The Director manages benefit configuration, ensuring compliance and effective structure. Oversees team performance and collaborates across departments for operational efficiency and regulatory adherence.

Manage utilization management functions and supervise RN/social work/care coordination teams. Ensure appropriate, cost-effective member services via authorizations, chart review, EMR documentation, staff coaching, operational reporting, and regulatory compliance with CMS/DOH.

Manage claims-related modernization initiatives, oversee project reports, collaborate with IT, and implement process improvements in a healthcare setting.

Lead strategic, cross-functional performance improvement initiatives to optimize clinical and operational performance, build organizational capability, and deliver measurable financial and customer outcomes through process optimization, automation, AI-enabled solutions, change management, and stakeholder engagement.

Support development and maintenance of actuarial forecasting models for monthly forecasts and annual budgets. Analyze large healthcare claims, membership, and financial datasets to monitor performance, identify trends and drivers, and communicate variances. Collaborate with finance and cross-functional teams to set assumptions, produce dashboards and reports, improve forecasting methodologies, and deliver actionable insights across Medicaid, Medicare, Commercial, and Long-Term Care lines.

The Director, Workforce Analytics leads the workforce analytics function, transforming data into insights to optimize talent strategy and support organizational goals through analytics and reporting.

Serve as Product Owner for Provider Data Operations: define product vision, prioritize and maintain backlog, author and accept user stories, create UAT test cases, support Agile/Scrum processes, collaborate with cross-functional and stakeholder teams, drive process improvements, and ensure delivery of high-quality features. Hybrid role (Tues/Wed/Thurs in NYC).

Support the Provider Risk Analytics team by performing data analysis and projects to monitor cost and revenue trends, identify improvement opportunities, model impacts for provider organizations, attend provider meetings, and learn value-based care and risk modeling.

Serve as Product Owner for enrollment and billing correspondence systems: prioritize backlog, write and accept user stories, lead UAT, drive process improvements, partner with cross-functional teams, and ensure Agile best practices and product strategy alignment.

Front-line community office coordinator who greets and triages members, registers and educates portal users, audits applications, manages office inventory and mail, tracks activity metrics, escalates issues to Sales/IT/Billing, trains staff on common errors, and opens/closes the office while protecting member privacy and PHI.

The Senior Manager, HR Technology & Integration oversees the HR technology infrastructure, ensuring integration, configuration, and data flow across platforms, while leading a small team. They enhance system reliability and efficiency, monitor integrations, and resolve technical issues.

The Senior Product Specialist leads product initiatives, collaborates with various teams, and manages documentation for successful execution of projects in the product portfolio.

Lead strategy, design, and execution of HR technology solutions, driving data architecture, governance, integrations, vendor management, reporting/analytics, AI use cases, and team development to improve employee experience and operational outcomes.

The AVP of Community Engagement leads strategies to enhance community health, improve member health outcomes, and operationalize initiatives aligning with marketing and enterprise objectives. Responsibilities include managing a team, executing community strategies, tracking outcomes, and building partnerships with local organizations.