[Hiring] A&G Non-Clinical Specialist @HFMS HF Management Services, LLC
Apr 05, 2025 - HFMS HF Management Services, LLC is hiring a remote A&G Non-Clinical Specialist. đź’¸ Salary: $49,795 - $76,960. đź“ŤLocation: USA.
Role Description
The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. A&G works in collaboration with divisions within and outside the organization to resolve issues in a timely and compliant manner. The A&G Specialist is the subject matter expert responsible for non-clinical case development and case resolution while ensuring compliance with Federal and/or State regulations. The A&G Specialist will manage his/her own caseload and is accountable for investigating and resolving member or provider initiated cases. Manages all Department of Health (DOH) and executive complaints as needed. The incumbent may also handle non-clinical claim appeals that come from Healthfirst participating and non-participating providers. This is full-time on-site position located at either the 100 Church Street location in New York City or the 1101 Greenwood Avenue location, Lake Mary, Florida. This position may require attendance at A&G/ Operations divisional meetings and Town Halls, some of which may require travel to one of the locations (T&E will be covered according to policy).
Duties and Responsibilities
- Responsible for case development and resolution of non-clinical cases, such as certain types of claim denials, member complaints, and member and provider appeals.
-
The end-to-end process requires the Specialist to independently:
- Research issues
- Reference and understand HF’s internal health plans’ policies and procedures to frame decisions
- Interpret regulations
- Resolve cases and make critical decisions
- Edit and finalize resolution letters
- Manage all duties within regulatory timeframes
- Communicate effectively to hand-off or pick-up work from colleagues
- Work within a framework that measures productivity and quality for each Specialist against expectations
- Additional duties as assigned
Qualifications
- Bachelor’s degree from an accredited institution or relevant work experience
Preferred Qualifications
- Minimum of two (2) years of work experience in Managed Care or Health Insurance
- Work experience in claims, customer service, home health, hospital or doctor’s office preferred
- Experience working in care management systems, such as CCMS, TruCare or Hyland
- Demonstrated critical thinking and decision-making competencies
- Highly effective communication, organizational, and customer service skills
- Demonstrated ability to be detail oriented, work under pressure, manage tight timeframes
Hiring Range
- Greater New York City Area (NY, NJ, CT residents): $57,408 - $76,960
- All Other Locations (within approved locations): $49,795 - $72,800
Benefits
- Medical, dental and vision coverage
- Incentive and recognition programs
- Life insurance
- 401k contributions (all benefits are subject to eligibility requirements)
Equal Opportunity Employer
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
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. In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying.
Similar Remote Jobs
More jobs at HFMS HF Management Services, LLC
-
QA $47,403 - $62,400 (ny, nj, ct) / $41,101 - $60,320 (other locations) USAApr 13, 2025
-
All others $81,100 - $117,470 (greater nyc area) USAApr 13, 2025
-
All others $81,100 - $117,470 USAApr 05, 2025
More Customer Service jobs
-
Customer Service competitive annual salary based on experience Germany, AustriaApr 16, 2025 -
Customer Service unspecified PhilippinesApr 16, 2025
More jobs in USA
-
Project Management unspecified USAApr 16, 2025
Kickstart Your Job Search
Unlock 54,785 additional remote jobs, advanced search & email notifications
Too many emails? Declutter your inbox with Meco
Your home for reading newsletters
| đź“Ť | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
|
Salary
đź’¸
$49,795 - $76,960
|
Remote
Location
USA
|
|
Job Type
full-time
|
Posted
Apr 05, 2025
|
| đź“Ť | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
