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Operations Analyst - 100% Remote

FL Req ID: R016384 Remote
Duties & Responsibilities:  Complete daily, weekly and monthly analysis, reports, summaries and dashboards Receive and respond to inquiries and complaints and interface with internal and external personnel Support audit, compliance and regulatory responsibilities Meet SLA guidelines in creating...
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Operations Trainer

FL Req ID: R020100 Hybrid
-Facilitate and Delivery Training - conduct new hire, refresher and skills enhancement training for all operational areas, utilizing varying delivery methods based on business and audience needs, to include: Synchronous and Asynchronous (Live instructor led classroom and webinar capacity...
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Path 29 (00336 Paydoc Program)

NY Req ID: R016112 Hybrid
Duties/Responsibilities: Works with the AVP of Pharmacy Benefits and the Clinical Pharmacy Director to design and manage the Healthfirst Pharmacy Benefit for all Medicare plans. Strategically leads the development, planning and implementation of the annual pharmacy benefit cycle to ensure that...
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Payroll Admin

LA Req ID: R018739 Remote
Manager Support – Work with Asst. Director of Payroll to develop polices and procedures in the payroll department.Oversee day to day payroll operations in area of responsibility utilizing the Workday platform.Audit the work of staff members in area of responsibility.Partner Service – Respond to...
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PEGA Business Analyst

Remote
Job Description SummaryThe Pega Business Analyst is responsible to improve process effectiveness and efficiency through Pega solutions that accelerate Healthfirst’s strategic operational objectives and transform the experience for our Provider Partners, Customers and employees.Job...
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Pega Developer, BG TEST

FL Req ID: R016580 Remote
• Designs, develops, and maintains complex applications • Develops unit tests and provides code coverage to accurately test business logic and functionality • Participates in developing specifications such as user stories and designs • Solves or recommends solutions for complex issues and...
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Per - Care manager-21

Req ID: R016357 Remote
Duties/Responsibilities: Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. Conducts assessments to identify barriers and opportunities for intervention. Develops care plans that align with the physician’s treatment plans and recommends...
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Pharmacy Technician

TX Req ID: R016064 Remote
Duties & Responsibilities: Performs review of medication lists to understand and eliminate barriers to medication therapy while serving as the member's Pharmacy Navigator in order to achieve the following:Proper Medication Adherence Minimize any gaps in therapy Prevention of medication related...
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Policy & Process Analyst

NY Req ID: R017197 Remote
Duties & Responsibilities: Writing, formatting, editing, and validating various technical documents. Ensuring all documentation uses standard templates. Interpret Technical Data - Analyzes and interprets technical data to determine relevant material for publication by collaborating with subject...
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Product Owner

NY Req ID: R016585 Hybrid
Duties & Responsibilities: Define & communicate the overall vision, objectives and goals of the business. Articulate the minimum viable product needs. Create, refine, socialize and prioritize the Product backlog. Enable delivery of Product Backlog by presenting backlog to team; creating, owning...
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Provider Ops Rep

FL Req ID: R020097 Remote
Job DescriptionConducting comprehensive and thorough review of requests for Provider profile set-up and/or updates initiated by other departments and received via Macess, fax, or e-mail for accuracy and completeness. Collaborating with internal and external customers to obtain any missing...
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PT - Email Reminder

NY Req ID: R016348 Remote
Duties and Responsibilities: Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension of services. The end to end process requires the...
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QA Analyst

Req ID: R016368
• Receive Incoming calls from members regarding: o Benefit questions/issues, o Care management referrals/inquiries, connecting to their care manager, and screening tools to identify risk factors requiring care management intervention o Inquiries about programs, o Provision of educational...
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