Job Overview
Location
Remote
Job Type
Full-time
Category
Operations
Date Posted
April 4, 2026
Full Job Description
đź“‹ Description
- • The IDR Resolution Specialist independently manages a caseload of appeal cases, preparing appeal packets for external review and ensuring timely, compliant resolutions in accordance with state and federal regulations.
- • Day-to-day responsibilities include researching issues, applying Healthfirst policies and regulations, preparing and editing case files and letters, managing the Independent Dispute Resolution (IDR) process, monitoring submissions and timelines, and ensuring compliance to achieve fair and timely resolution of payment disputes.
- • The specialist serves as a point of contact with regulators, entities, and providers to ensure requests are handled accurately and timely while upholding company policies and regulatory standards.
- • The role involves maintaining accuracy in OnBase cases, building evidence packets per job aid, submitting packets to OAH via FTP, and maintaining productivity, quality standards, and HIPAA compliance.
- • The position is part of Healthfirst, Inc., a healthcare organization committed to equitable employment practices and compliance with all applicable laws and regulations.
- • The specialist can develop expertise in healthcare appeals, regulatory compliance, and case management systems while contributing to fair resolution of payment disputes in a remote work environment.
🎯 Requirements
- • HS Diploma or GED from an accredited institution
- • Experience in claims, customer service, or healthcare settings
- • Detail-oriented, able to work under pressure, and meet tight deadlines
- • Collaborative and organized work style
- • Familiarity with systems such as OnBase, TruCare, or Hyland (preferred)
- • Previous experience in managed care, health insurance, or appeals (preferred)
🏖️ Benefits
- • Medical, dental, and vision coverage
- • Incentive and recognition programs
- • Life insurance and 401k contributions
- • Competitive compensation and benefits package
- • Remote work eligibility
- • Equal opportunity employer with commitment to diversity and inclusion
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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