Jobs at Healthfirst - Page 6

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Infrastructure Architect

Healthfirst - New York, NY

Responsibilities: Serves as the subject matter expert to provide strategic oversight and planning of enterprise initiatives to ensure infrastructure components are properly designed in alignment with enterprise infrastructure strategies. Reviews and recommends infrastructure technologies to meet business needs/& priorities and to align with enterprise strategies. Develop...

Business Analyst, Claims Analytics (Business Transformation)

Healthfirst - New York, NY

Responsibilities: Analysis, Reporting and Performance Improvement: Analyze various types of data and processes in a versatile manner and present findings and recommendations in a professional manner. Manipulate data to root cause, trend, summarize findings and offer recommendations. Identify defects and improve departmental performance by supporting quality,...

BI Solutions Architect

Healthfirst - New York, NY

Responsibilities: Multiple years of experience in BI architecture design, multidimensional data modeling, datamart design, data security, ETL, and process modeling Strong written and verbal communication skills Strong collaboration skills Ability to mentor High energy, focused on the goal, definitive Ability to multitask, and a good judge of where...

Senior Actuarial Analyst

Healthfirst - New York, NY

Responsibilities: Handle premiums, claims, enrollment, and administrative expense data for reports to government and regulatory entities such as Centers for Medicare Medicaid Services (CMS) and New York State Department of Health (NYSDOH) and routine internal reports Perform risk score analytics and Part D PL reporting and analysis Support the Medicare bidding pr...

Manager, Strategic Network Partners - Delegated Vendors

Healthfirst - New York, NY

Responsibilities: Manages and resolves all issues related to ancillary delegated relationships. Acts as a liaison between other departments and delegated providers for information including audits, member complaints, etc. Collaborates with Delegate Oversight division of the Quality Improvement Department to ensure that all sections of the Pre-Delegated Oversight Tool are complete and ac...

System Security Engineer

Healthfirst - New York, NY

Responsibilities: Leading problem analysis, solutions development and implementation, and decision making that significantly impacts enterprise-wide System Security initiatives. Serve as Project Manager for multiple information security projects; gap analysis, vendor product evaluations, current systems maintenance, and new system implementations Assist in the management...

Organizational Capability Specialist (Learning and Development)

Healthfirst - New York, NY

Responsibilities: Facilitate a variety of programs ranging from one hour to multi-day programs conducted in a classroom or online learning environment. Sessions may include product-specific training and skill development i.e. New Hire Orientation, presentation skills, exceptional customer service, and time management. Collaborate in the custom design, development and m...

Clinical Regulatory Manager

Healthfirst - New York, NY

Responsibilities: Act as Project Manager within CPM Department in managing all aspects of regulatory reporting requirements including drafting responses for NYDOH and CMS CAP requirements timely and accurately. Manage and coordinate reports and meeting documentation for Behavioral Health quality and utilization management committees. Work with a wide variety of Departmen...

Senior Clinical Analyst - Clinical Analysis

Healthfirst - New York, NY

Responsibilities: Uses appropriate analytic tools to provide data-based responses to internal and external requests for information related to clinical performance of members or providers. Examines member demographics, claims and provider data, case management information Extracts, transforms and modifies datasets to satisfy internal and external requests for informati...

Medical Records Coordinator

Healthfirst - New York, NY

Responsibilities: Perform quality checks to maintain the integrity of events and criteria for reporting purposes. Process members' electronic documents proof data for inaccuracies or missing information. Resolve discrepancies identified using standard procedures and/or returning incomplete documents to their respective departments for correction and resolution. R...

Senior Healthcare Analyst (Medical Economics)

Healthfirst - New York, NY

Responsibilities: Provide analytical support for the Claims, Ancillary, Medical Management and Provider Network departments. Analyze the financial performance of all Healthfirst products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management. Create financial models to evaluate the impact of provid...

SAS Programmer/Analyst

Healthfirst - New York, NY

Responsibilities: Create, maintain and optimize SAS programs to support Finance Analysis data process. Document all coding, methodology and assumptions, data issues and report results for each analysis. Utilize research methods to analyze various data sets to support material financial adjustments for all Healthfirst products. Gather data and conduct ad-hoc analy...

System Administrator - Pega

Healthfirst - New York, NY

Responsibilities: Work with the development team to ensure that designs effectively accommodate long-term maintainability, supportability, robustness, and scalability of software solutions Keeping abreast of patches including minor and major version releases Evaluating merits and risks of upgrades; coordinating with appropriate staff to execute patches to deployed applic...

Enterprise Architect

Healthfirst - New York, NY

Responsibilities: Develop and maintain the Enterprise data model and data integration patterns that would align/integrate with a "Logical Data Warehouse", "Operational Data Stores", "Enterprise Data Warehouse", Data Integration contracts(EDI and custom), MDM data models, Data Marts and transaction application data models. Maintain alignment of the Enterprise Data Model with the E...

CRM Program Manager

Healthfirst - New York, NY

Responsibilities: Partner with the business, Information Technology and implementation team to capture all aspects of the program into one program plan with the appropriate level of detail and clearly identified interdependencies. Planning, directing and coordinating project activities through the entire project life cycle (from initiation to close). This includes setting clear...