Appeals and Grievances Clinical Specialist
Healthfirst
About this role
The Clinical Specialist in Appeals & Grievances is responsible for managing clinical cases related to member complaints, grievances, and appeals within a healthcare organization. They investigate, develop, and resolve cases independently, ensuring compliance with regulations and internal policies. The role involves collaboration, documentation, and preparation of cases for review and appeals processes.
Skills
Qualifications
About Healthfirst
healthfirst.orgHealthfirst is a not‑for‑profit health insurer focused on serving New Yorkers with a range of plans including Medicaid, Medicare Advantage, Child Health Plus, the Essential Plan, and individual & family coverage across New York City, Long Island, Westchester and nearby regions. The company emphasizes coordinated, community‑focused care through a large provider network, care management programs, preventive services, and support for social needs. Healthfirst provides member tools and customer support for plan selection and access to services, and runs quality and population‑health initiatives aimed at improving outcomes and reducing disparities.
Salary
$73k – $120k
per year
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