Job Overview
Location
Remote
Job Type
Full-time
Category
HR & Recruiting
Date Posted
May 22, 2026
Full Job Description
đź“‹ Description
- • The Appeals and Grievances Clinical Specialist role is critical to ensuring fair and timely resolution of member concerns regarding healthcare services, directly impacting member satisfaction and regulatory compliance.
- • Day to day, the specialist will review and investigate appeals and grievances submitted by members, analyze clinical documentation, apply clinical guidelines and policies, and communicate decisions clearly to members and providers.
- • The role is part of Healthfirst’s Clinical Operations team within HF Management Services, LLC, supporting the company’s mission to provide quality healthcare access to underserved communities in New York.
- • In this role, the specialist will develop expertise in healthcare appeals processes, strengthen clinical judgment in utilization management, and gain experience navigating complex regulatory requirements in a managed care environment.
🏖️ Benefits
- • Fully remote work arrangement
- • Opportunity to work with a mission-driven organization focused on health equity
- • Exposure to clinical operations and healthcare policy in a managed care setting
- • Professional development in utilization management and member advocacy
- • Stable employment with a reputable nonprofit healthcare organization
- • Support for continuing education and license maintenance (implied through role requirements)
Skills & Technologies
About Healthfirst, Inc.
Healthfirst is a New York-based health insurance provider offering affordable, comprehensive plans to individuals, families, and seniors. For over 30 years, the company has delivered diverse options, including Essential Plans, Medicaid Managed Care, Child Health Plus, Marketplace plans, and specialized Medicare Advantage and Long-Term Care solutions. Healthfirst offers benefits like medical, prescription drug, dental, and vision coverage. Notably, Healthfirst maintains the only 5-star rated Essential Plan in New York for two consecutive years, solidifying its position as a trusted leader in accessible community healthcare.
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