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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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QA Kainos - Test Manager

NY Req ID: R020019 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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QA Sr. Test Manager

NY Req ID: R020061 Remote
• Test planning and execution• Ensure all strategic projects and operational projects meet the highest quality possible by following industry recognized testing methodologies and best practices.• Provide oversight and overall test execution management of all system and integrated release testing...
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QA Test Manager

NY Req ID: R020197 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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QA Test Manager

NY Req ID: R020016 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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QA Test Manager

NY Req ID: R020079 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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QA Tester

NY Req ID: R018727 Remote
Duties & ResponsibilitiesEvaluate the design and effectiveness of controls to manage risk within our risk appetite and toleranceAudit activities of various groups for compliance with key controls compliance with plans, policies, procedures, regulatory requirements and best practices.Perform...
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Quality Engineer

NY Req ID: R018703 Remote
Duties & Responsibilities:Aligns Testing Support Services under the Quality Assurance Team for strategic planning as it pertains to organization standards.Builds the testing process and policies along with defining technical solutions and tools to support the testing framework.Ensures that...
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