
1001 - 5000 employees
Founded 1993
🛡️ Insurance
🏥 Healthcare
⚕️ Healthcare Insurance
Insurance • Healthcare • Healthcare Insurance
Healthfirst is a health insurance provider dedicated to helping New Yorkers access affordable health coverage for individuals and families. With over 30 years of experience, Healthfirst offers a range of plans including Medicaid managed care, Medicare Advantage, long-term care, and essential health plans. The company focuses on providing quality healthcare options, comprehensive benefits, and support to ensure members can maintain their health and well-being.
🔥 14 hours ago
🦌 Connecticut, New Jersey, +1 more states – Remote
đź’µ $34.9k - $54.6k / year
⏰ Full Time
🟡 Mid-level
đźź Senior
🦅 H1B Visa Sponsor
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1001 - 5000 employees
Founded 1993
🛡️ Insurance
🏥 Healthcare
⚕️ Healthcare Insurance
Insurance • Healthcare • Healthcare Insurance
Healthfirst is a health insurance provider dedicated to helping New Yorkers access affordable health coverage for individuals and families. With over 30 years of experience, Healthfirst offers a range of plans including Medicaid managed care, Medicare Advantage, long-term care, and essential health plans. The company focuses on providing quality healthcare options, comprehensive benefits, and support to ensure members can maintain their health and well-being.
• Assist care/case managers with non-clinical activities such as creating cases and events • Provide telephonic outreach to members, providers and community-based organizations • Handle member mailings • Fax clinical requests and Individual Health Care Plans on behalf of care/case managers • Conduct outreaches for newly enrolled members to review current and approved services, DME and additional requests • Review intake documents for pre-approved services and escalate discrepancies as needed • Complete Welcome Onboarding and Consumer Directed Personal Assistant Assessments and identify issues or risk factors requiring clinical escalations • Initiate and finalize authorization in Trucare for preapproved services and DMEs; update and discontinue authorizations when applicable • Handle and accurately document calls from and to members regarding benefit questions/issues, appointments, assessments, service issues and grievances • Handle and accurately document calls from and to providers regarding authorizations, referrals, visits, tests and faxed care plans • Educate members and providers regarding requirements for approval of service requests • Manage a large caseload while communicating member issues or needs and monitoring screening of members to improve quality and cost outcomes • Communicate with Inter/Intra-departments regarding reconciling onboarding issues • Perform additional duties as assigned
• High School diploma or GED equivalent • Experience in a customer service environment • Experience working in a fast-paced environment that requires handling multiple priorities simultaneously • Work experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skills • Knowledge of medical terminology • Ability to manage a caseload of 200+ cases • Knowledge of Trucare, Salesforce, HHAXchange, DocuSign Epaces, Sharepoint and Monday.com • Experience in managed care or other area of the healthcare industry working in a Call Center environment or Care/Case Management Department • Experience with Microsoft Office Suite applications including Excel, Word, Outlook, and MS Teams • Demonstrated ability to document calls into a computer system
• Medical, dental and vision coverage • Incentive and recognition programs • Life insurance • 401k contributions • Competitive compensation and benefits package
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