Job Overview
Location
Remote
Job Type
Full-time
Category
HR & Recruiting
Date Posted
April 15, 2026
Full Job Description
đź“‹ Description
- • The Appeals and Grievances Quality Assurance Auditor at Healthfirst, Inc. is responsible for ensuring compliance with policies, procedures, and quality standards through internal audits of operational processes for employees and outsourced vendors, directly supporting regulatory adherence and service quality in healthcare appeals and grievances.
- • Day-to-day responsibilities include conducting quality audits of appeals and grievances (pre-service, post-service, and grievance items), analyzing eligibility, claims, authorizations, and service forms; performing root cause analysis; tracking and trending findings; preparing written reports; presenting results to senior staff; and assisting in policy development and training efficiency reviews.
- • Healthfirst is a mission-driven healthcare organization committed to improving health outcomes for diverse communities, with a strong emphasis on compliance, operational excellence, and cultural drivers such as integrity, accountability, and collaboration.
- • In this role, the auditor will develop expertise in healthcare regulatory compliance, root cause analysis, quality improvement methodologies, and cross-functional collaboration—gaining valuable experience in audit processes, data trending, and healthcare operations that support career growth in quality assurance, compliance, or healthcare administration.
🎯 Requirements
- • Experience with the investigation, resolution, and reporting of appeal and grievance processes.
- • Proficiency in Microsoft Office suite, including Excel (formulas, data formatting, filtering), Word (document creation/editing), and PowerPoint (presentation creation/editing).
- • High School Diploma or GED from an accredited institution.
- • Associate degree from an accredited institution (preferred).
- • ICD10 certification (preferred).
- • Experience conducting audits with root cause analysis (preferred).
🏖️ Benefits
- • Medical, dental, and vision coverage.
- • Incentive and recognition programs.
- • Life insurance and 401k contributions (subject to eligibility).
- • Competitive hiring range: $58,900–$80,070 for Greater New York City Area; $51,000–$74,880 for all other approved locations.
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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