Appeals Specialist
Healthfirst
About this role
The Appeals Specialist in the Appeals & Grievances unit is a subject matter expert responsible for non-clinical case development and resolution of member and non-contracted provider appeals across Health Plan lines of business. The role ensures compliance with federal and state regulations, manages an independent caseload, and is accountable for investigating and resolving initiated cases.
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
$51k – $80k
per year