Configuration and Quality Audit Analyst | Hybrid NY HealthfirstConfiguration and Quality Audit Analyst | Hybrid NYNew York, NY$68,900–$99,620 / yearAt least three years of experience in a managed care organization, commercial health plan, government program, third-party administrator, or other healthcare operations environment performing claims analysis, configuration audit, provider reimbursement, payment integrity, or healthcare data analysis. Candidate must display effective communication skills and have detailed skillset to configure Office365, effectively communicate product updates, interface with the vendor on potential issues, and ensure platform governance rules are followed.
NewAssociate, Payment Integrity IBR Oscar Health IncAssociate, Payment Integrity IBRNew York, NYRemote$82,717–$108,566 / yearThis is accomplished by leveraging a deep understanding of Oscar''s claim infrastructure, workflows, workflow tooling, platform logic, data models, etc., to work cross-functionally to understand and translate friction from stakeholders into actionable opportunities for improvement. Proactively identify and document potential billing errors, including duplicate billing of items, services, or procedures as improper unbundling of services (e.g., separating components that should be billed together) and charges for non-covered or non-rendered services.
NewStaff Product Manager, Insurance HOVER IncStaff Product Manager, InsuranceNew York, NYRemote$186,000–$260,000 / yearHover has Hubs in San Francisco and New York City, where we expect that all employees living within a 50-mile radius of our offices will come into their local Hover office at least three times a week to build rapport and foster organic connection. Backed by leading investors like Google Ventures and Menlo Ventures, and trusted by industry leaders including Travelers, State Farm, and Nationwide - we're redefining how people understand and interact with their spaces.
Senior Ai/Ml Engineer Starr CompaniesSenior Ai/Ml EngineerNew York, NY$180,000–$200,000 / yearThe wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets: experience and training: licensure and certifications: and other business and organizational needs. 5+ years' experience with data science/machine learning techniques (e.g., logistic regression, hierarchical regression, decision tree, random forest, neural networks, etc.) and 2+ years of experience working with LLM.
Trainer I Horizon Healthcare ServicesTrainer INewark, New Jersey56,200 - $75,285 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This position is responsible for delivering service training programs across enterprise sites and remote vendor locations while supporting the development and continuous improvement of learning solutions.
Assistant Manager, Post Audit Operations ExlService Holdings IncAssistant Manager, Post Audit OperationsNY$23–$38 / hourEXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others.
Quality Analyst - Data Mining, Payment Integrity ExlService Holdings IncQuality Analyst - Data Mining, Payment IntegrityNYRemote$75,000–$90,000 / yearThis position is responsible for reviewing completed audit findings, validating overpayment opportunities, confirming claim repricing accuracy and supporting documentation, and ensuring audit work aligns with client requirements, coding guidelines, pricing rules, and claim payment methodologies. The ideal candidate brings strong healthcare claims knowledge, analytical thinking, attention to detail, and the ability to provide clear feedback that supports auditor performance, continuous improvement, and stronger recovery outcomes.
Privacy Intern XpansivPrivacy InternNew York, NY$20–$25 / hourTrusted worldwide, Xpansiv enables stakeholders to deliver transparent, credible, and auditable environmental claims to address the growing global demand for assurance and accountability on climate action and sustainability performance. Currently pursuing a later-stage undergraduate degree or a graduate degree (Master’s or Juris Doctor / law degree preferred) in a related field (e.g., law, privacy, compliance, risk management, information security, public policy, or business).
Director Configuration, Benefit Administration HealthfirstDirector Configuration, Benefit AdministrationNew York, NY$154,600–$236,555 / yearThis role implements the configuration structure within Healthfirst's technology platforms to administer benefits taking in coordination with Provider Contracting, Claims Operations, Provider Data Management, Clinical Operations, Payment Integrity, and Information Technology. The objective of this role is to ensure that the benefit structure implementation delivers the intended experience through claim adjudication, including benefits, authorizations, reference data, claims editing, regulatory requirements, payment policies, and overall claim system functionality.
Dir Configuration, Benefit Administration HealthfirstDir Configuration, Benefit AdministrationNew York, NY$154,600–$236,555 / yearThis role implements the configuration structure within Healthfirsts technology platforms to administer benefits taking in coordination with Provider Contracting, Claims Operations, Provider Data Management, Clinical Operations, Payment Integrity, and Information Technology. The objective of this role is to ensure that the benefit structure implementation delivers the intended experience through claim adjudication, including benefits, authorizations, reference data, claims editing, regulatory requirements, payment policies, and overall claim system functionality.
Medical Collector/Biller Integrated ENT, Allergy and ImmunologyMedical Collector/BillerWoodbury, NY$50,000–$60,000 / yearFull timemanaging outstanding insurance and patient accounts, resolving billing discrepancies, appealing denied claims, and ensuring timely reimbursement while delivering exceptional. • Associate degree in Business Administration, Healthcare Administration, Accounting, or a related field preferred, or an equivalent combination of education.
Billing Specialist LOA Zufall HealthBilling Specialist LOADover, NJ$19.50–$22.61 / hourUnder the direct supervision of the Revenue Cycle Manager, the Billing Specialist LOA will be responsible for reviewing eligible claims for submission to the State (LOA). Validating/Confirming patient payments is a part of Billing meetings regarding loss of revenue due to missing payments.
NewCPC Investigator Horizon Healthcare ServicesCPC InvestigatorNewark, New JerseyThe Certified Professional Coder (CPC) is responsible for performing reviews, audits and coding oversight of medical records to ensure the appropriate CPT codes, diagnosis codes and modifiers according to Generally Accepted Medical Coding Guidelines, CPT-4; HCPCS; ICD-10 Guidelines; and, CMS Correct Coding. $70,500 - $94,395 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.
Senior Accountant RhinoSenior AccountantNew York, NY$90,000–$115,000 / yearHandle complex accounting areas such as revenue recognition (ASC 606), prepaid/accrued expenses, equity, and insurance-related balances (e.g., premiums receivable, claims reserves, carrier settlements, carrier payables, and fiduciary assets/liabilities) across multiple carrier programs while serving as the primary finance liaison to insurance operations and actuarial teams. This is a great role for someone who wants broad exposure across a fast-growing fintech/insurtech business - including the interesting accounting that comes with insurance products, premiums, and claims.
Pharmacy Technician ICARE PHARMACY PLUSPharmacy TechnicianPaterson, NJFull timeJob Description: Icare Pharmacy Plus in Paterson, NJ is looking for a highly motivated and detail-oriented Pharmacy Technician to join our dynamic team. The successful candidate will support the pharmacist in preparing and dispensing medications, delivering exceptional customer service, and ensuring full compliance with all relevant laws and regulations.
Medicaid Billing Administrator - Intern (Unpaid) Neuropath Healthcare SolutionsMedicaid Billing Administrator - Intern (Unpaid)Union, New JerseyThe Medicaid Billing Administrator Internship at Neuropath Behavioral Healthcare is designed to provide students and recent graduates with practical training and exposure to healthcare billing processes. Interns will gain hands-on experience in Medicaid claims processing, billing compliance, and healthcare administration while working under the direct supervision of experienced billing professionals.
Commercial SME(Commercial Analytics Consultant (Pharmaceutical Domain DS TechnologiesCommercial SME(Commercial Analytics Consultant (Pharmaceutical DomainPiscataway, New JerseyProvide functional leadership on the management and utilization of Longitudinal Access and Adjudication Data (LAAD), ensuring the successful integration of longitudinal data to support patient-centric commercial activities. Act as the primary SME for commercial operations, providing insights and leadership in Sales, Marketing, Incentive Compensation (IC), Patient Data Management, Longitudinal Access and Adjudication Data (LAAD), and Claims.
Manager of Clinical Appeals and Grievances HealthfirstManager of Clinical Appeals and GrievancesNJ$103,400–$149,430 / yearProvides guidance in the preparation of case preparation for Medical Director Review ensuring that all pertinent information (i.e. case summary, contract information, internal and external responses, diagnosis, and CPT codes and descriptions) has been obtained during investigation and is presented as part of the case. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798.
NewProduct Management Senior Advisor - Express Scripts - Hybrid CignaProduct Management Senior Advisor - Express Scripts - HybridMorris Plains, NJ$113,200–$188,600 / yearThese states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Senior Quality Analyst, Assistant Manager ExlService Holdings IncSenior Quality Analyst, Assistant ManagerNY$73,000–$110,000 / yearEXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. This role will be responsible for embedding AI into QA processes, improving product quality proactively, and driving intelligent automation initiatives that reduce manual effort, improve defect prevention, and accelerate delivery timelines.