Healthfirst

Business Analyst

• Reviewing business processes to gain a complete understanding of current business and system processes
• Identifying improvements and documenting those improvements as business requirements
• Working interdepartmentally, making decisions, and communicating to leadership to ensure deliverables are met
• Defining and eliciting business requirements for assigned project or company initiatives
• Communicating departmentally and interdepartmentally to recommend and request new concepts and/or modifications to existing workflow, system set up, tools and designs
• Identifying defects and improving departmental performance by supporting quality, operation efficiency and production goals
• Collaborating with business units to understand strategic goals and promote an environment conducive to creativity, change and information exchange
• Creating documentation for business processes and collaborating with teams to share knowledge
• Analyzing various types of data and processes to root cause, trend, and summarize findings
• Presenting findings and recommending changes to address deficiencies and/or further improve performance
• Maintaining active communication on project updates with leadership

Technical Business Analyst

Human Resources

• Leads and manages the full suite of talent lifecycle activity
• Partners with business leaders to deliver human capital solutions
• Acts as a strategic advisor to technology leaders
• Focuses on talent retention, organizational structure, and change management
• Bridges the gap between IT leadership priorities and employee experience
• Develops people strategies to meet operational goals
• Engages appropriate HR Centers of Excellence as needed to accomplish projects and programs
• Maintains a strong curiosity mindset to continuously learn about the organization and HR best practices

Senior Manager, HRBP - IT

Director

• Partners with Enterprise Delivery Services, the business, Information Technology and implementation teams to capture all aspects of a portfolio of projects/programs.
• Partners with key business stakeholders to define portfolio objectives and works with various stakeholders on planning and delivery.
• Oversees the execution of multiple projects, resource deployment and overall coordination efforts to ensure initiatives are completed on schedule and to budget.
• Plans, directs and coordinates project activities through the entire project life cycle.
• Creates and executes plans and other required documentation designed to meet stated goals using Healthfirst project management tools and principles.
• Ensures the achievement of project objectives and drives business value by guiding teams through execution and stabilization.
• Actively manages all stakeholder expectations and relationships.
• Drives teams to resolution of issues/risks, including facilitating mitigation strategies.
• Partners with Change Management resources to ensure that communication and training are defined, planned for and delivered as appropriate.
• Actively facilitates discussions to address issues including risk management within and across associated projects and presents information to key stakeholders including committees, project sponsors and leaders at all levels.
• Meets financial objectives by forecasting requirements, communicating goals, objectives and responsibilities, keeping the project focused in terms of scope, schedule, communication and risk.

Director, Enterprise Delivery Services – Clinical

Analyst

• Execute forecasting and capacity planning activities in a multichannel contact center environment
• Develop and manage forecasts and staffing plans
• Partner with leadership on forecasting processes including data preparation and model updates
• Ensure forecasts are accurate and aligned with business inputs
• Translate demand into actionable staffing plans and monitor forecast performance
• Support ongoing capacity planning and validate assumptions impacting forecasts
• Produce regular reporting on forecasts, staffing plans, and KPIs.
• Identify opportunities for process improvements in forecasting tools.

Forecast Planning Analyst

Project Manager

• Lead end-to-end implementation of AI-enabled clinical platforms supporting UM, Care Management, prior authorization, population health, or related clinical operations
• Manage large-scale transformation initiatives involving workflow redesign, system integration, data migration, operational readiness, and change management
• Translate strategic objectives into actionable project plans with clear scope, timelines, financial targets, and measurable outcomes
• Manage a high-volume portfolio of large, cross-functional projects with significant operational, clinical, technical, financial, and regulatory interdependencies
• Translate operational and clinical requirements into executable implementation plans with technology teams and vendors
• Ensure AI solutions align with clinical operations, compliance standards, audit requirements, and user adoption objectives
• Partner with executive and senior leaders to drive alignment, facilitate decision making, remove barriers, and ensure accountability across stakeholder groups
• Standardize and apply project management best practices, tailoring methodologies as appropriate to initiative complexity and scope
• Establish and maintain project governance structure, including steering committees, status reporting, risk management, and escalation pathways
• Proactively identify and mitigate risks related to cost, scope, timelines, regulatory compliance, operational disruption, and organizational readiness and adoption
• Monitor and report on initiative performance, operational impact, financial benefits, and realization of return on investment
• Ensure projects are executed in accordance with Healthfirst policies, regulatory requirements, internal controls, and quality standards
• Drive effective change management to support adoption, sustainability, and realization of operational and business outcomes
• Provide clear, concise executive-level communications and presentations regarding project status, risks, dependencies, deliverables, and realized value
• Mentor and support Project Coordinators and Project Managers through coaching, project guidance, and operational leadership
• Perform additional duties as assigned

Senior Project Manager – Clinical Transformation

Strategy

• Work cross functionally to develop, execute, support, and improve strategies related to retention, growth, and financial performance
• Conduct in-depth research and market analysis
• Identify key member cohorts and opportunities for membership retention
• Develop a member retention strategy
• Collaborate across lines of business to execute market retention plans
• Participate in product driven workgroups
• Provide daily insight and reporting to teams on membership growth and performance
• Ensure communication across impacted areas

Manager, Medicaid Strategic Initiatives

Operations

• Provides high quality on-line and telephone assistance to all customers including brokers/agent and their uplines
• Provides high quality handling of customer inquiries, via mail, e-mail and chat sessions
• Resolves inquiries and issues relating to all aspects of broker/ agent business: Broker/Agent questions and issues regarding member eligibility, benefits, claims process, as well as product questions and various other customer support functions
• Broker/Agent questions and issues regarding onboarding, recertification and commissions
• Makes recommendations to management concerning problems, problem trends and process improvement
• Maintains an open exchange of information with internal and external customers
• Works with the Quality Assurance team to understand, track and trend quality performance issues
• Works a flexible schedule including a late shift and weekends, and as needed during the Annual Open Enrollment Period, Open Enrollment Period and during unforeseen business disruptions

Bilingual Sales Operations Service Agent – Spanish, Mandarin, Cantonese

Full-stack Engineer

• Works vertically and horizontally across the Infrastructure and Operations portfolio supporting private/public cloud systems, operating systems, middleware, storage, database platforms, and other key infrastructure products.
• Assists department leadership by providing informal coaching and direction to I&O Engineering team
• Subject matter expert for advanced analysis and resolution of the most complex issues
• Develops repeatable automation to deliver capabilities more efficiently.
• Devises solutions to problems impacting mission critical systems and implements automation to prevent reoccurrence.
• Supports and implements private cloud Hybrid Cloud Infrastructure (HCI) technologies.
• Plays a senior role within a Center of Excellence for cloud usage and cloud development standards.
• Maintains an accurate picture of existing server, storage, networking, software and hardware and virtual environments to support scaling against various project requirements.
• Ensures all usage of cloud environments meet governance standards and contributes to improving standards for security and operational efficiency.
• Creates Standard Operating Procedures (SOPs) for Healthfirst operations teams to support the operations of the products.
• Acts as a senior escalation point for operations and delivery teams for incident and ticket resolution and participates in an on-call rotation.
• Serves as a technical leader within Infrastructure & Operations as well as with Development teams in areas of Cloud technology and automation.

Principal Engineer, Cloud Systems

Compliance

• Responsible for promoting compliance with regulatory requirements with Healthfirst's different departments
• Meets with the Regulatory department to organize pre-survey deliverables and conduct reviews of materials
• Interacts with and represents the business unit
• Responds to auditor requests and audits outcome results
• Identifies organizational risks and helps implement process improvements
• Manages, coordinates, and participates in the implementation of contract changes for all lines of business
• Ensures that all process and contract changes are reflected in departmental policies and procedures
• Monitors all Utilization Management/Care Management/Appeals & Grievances corrective action plans (CAPs) through completion
• Assists in accreditation submissions, regulatory surveys, and internal audits
• Provides support to Pharmacy Department related to regulatory implementation efforts

Regulatory Specialist

Architect

• Establishes and governs enterprise process architecture standards, including process taxonomy, decomposition methods, workflow design patterns, documentation expectations, and governance practices
• Defines common methods for decomposing business capabilities into processes, subprocesses, decisions, tasks, system interactions, agent responsibilities, escalation paths, and control points
• Creates and maintains process reference architecture, reusable process modules, workflow components, decision services, automation services, and agent-enabled business services
• Partners with enterprise delivery programs to apply consistent process architecture practices across initiatives and align process designs to enterprise standards
• Defines human-agent workflow patterns that clarify how work is performed across people, AI agents, automation platforms, and enterprise systems
• Defines standards for incorporating AI agents into business processes, including accountability, decision rights, workflow boundaries, permissions, auditability, orchestration, and agent-to-agent interaction
• Identifies opportunities to redesign business processes around AI and agent capabilities rather than simply automating existing workflows
• Recommends process modernization opportunities using BPM, process mining, task mining, workflow analytics, and process intelligence methods
• Establishes process performance baselines and measurable outcomes for AI-enabled transformation, including cycle time, manual effort reduction, control effectiveness, and business value realization
• Ensures AI-enabled processes maintain alignment with regulatory, privacy, security, audit, responsible AI, and operational risk requirements
• Advises leadership and enterprise delivery programs on operating model evolution as AI agents increasingly participate in business execution
• Coaches architects, product owners, delivery teams, and business partners on process architecture, process decomposition, agentic process design, and human-agent workflow patterns.

Lead Enterprise Process Architect

Software Engineer

• Serve as a Qlik Cloud /QlikSense developer/Admin comfortable with creating reports / dashboards & extracts using transformation via multi-layered backend data models as well as front end dashboards or reports using Qlik technology platform (or similar)
• Develop complex healthcare related applications and NPrinting reports
• Customize scrambling methods for different QlikSense applications
• Analyze and understand functions to be automated, business needs, objectives, desired features, and input and output requirements
• Analyze, define, and document system requirements for data, workflow, logical processes, hardware and operating system environment, interfaces with other systems, internal and external checks and controls, and outputs
• Carry out data preparation in upstream data sources
• Analyze and estimate feasibility, time, and compatibility with other systems and computer capabilities
• Analyze, assist installs, and test upgrades of internally/externally developed application programs
• Design and develop programs/processes that automate specific business processes by working with various business units/departments to satisfy requirements
• Develop and maintain plans outlining steps and timetables for developing, testing, and installing applications
• Design and code screen layouts, graphical user interfaces, printed outputs, and interfaces with other systems
• Provide input on proposing, evaluating, and selecting appropriate design alternatives that meet client requirements and are consistent with client's current standards and processes
• Interact with business stakeholders for any clarifications required during the development stage
• Write and maintain functional and technical specifications
• Convert designs and specifications into code
• Write and maintain documentation to describe program development, logic, coding, testing, changes, and corrections
• Write documentation or review documentation written by others that describes installation and operating procedures
• Use Agile based project management tools like VersionOne/Agility
• Create test scenarios and work with QA team to run tests to identify errors and confirm program meets specifications
• Analyze codes to find causes of errors and revise programs
• Consult with business to prototype, refine, test, and debug programs to attain client approval
• Provide technical assistance by responding to inquiries regarding errors, problems, or questions with the program
• Train end users or technical support staff to use programs
• Monitor performance of programs after implementation

Application Developer/Manager – Digital Provider Collaboration Program

Technical Product Manager

• Lead delivery execution for assigned data capabilities, ensuring alignment to priorities, timelines, and quality expectations set by product and platform leadership.
• Manage and mentor a multidisciplinary team (onshore/nearshore/offshore as applicable), fostering collaboration, accountability, and continuous improvement.
• Partner with IT, architecture, and governance to implement scalable, secure, and compliant data solutions leveraging AWS services (e.g., S3, Glue, Lambda, Redshift, Athena).
• Translate business requirements into actionable features and user stories; support backlog readiness through refinement, estimation, dependency tracking, and acceptance criteria.
• Support stakeholder communication by providing clear status, risks, tradeoffs, and delivery transparency; escalate issues and decisions when needed.
• Participate in incident triage and production support for assigned data assets, helping drive root cause analysis, corrective actions, and prevention measures.
• Promote modernization and standardization by adopting reusable patterns, metadata-driven approaches, and improved pipeline reliability (including transition away from legacy tools where applicable).
• Champion data quality practices (validation, monitoring, lineage awareness, and documentation) to support regulatory reporting and analytics confidence.

Technical Product Manager, Production Support

Manager

• Provides daily oversight for Case Management teams
• Oversees utilization management functions including timely authorizations
• Develops and monitors goals for staff; provides ongoing feedback and coaching
• Collaborates with medical staff and reviews medical charts to obtain information for appropriate utilization management
• Allocate, monitor, and control resources while delegating and monitoring workloads
• Develops and analyzes operational and analytical reports to monitor operational efficiency
• Properly documents utilization management activities
• Functions as a clinical resource for the multi-disciplinary care team

Utilization Management Manager

Customer Success Manager

• Responsible for identifying, recruiting and onboarding new clients
• Support successful client implementations, ensuring clients have an excellent customer experience, adopt our tools and perform at the highest levels
• Document client business requirements and help validate that the final product solution meets business needs
• Build meaningful relationships with clients (e.g. providers, pharmacies, client data management vendors); serve as a primary point of contact for client inquiries, issues, and escalations
• Provide timely, accurate, and solutions-oriented product support; troubleshoot technical and functional issues, escalating complex matters as needed, act as a liaison between product, implementation and technical teams
• Maintain knowledge of company products and services to effectively support clients
• Identify recurring issues and recommend process or product improvements; work closely with all levels of end users to document business processes and workflows and begin identifying possible approaches to gaps, issues or risks
• Design, develop, and maintain client-facing and internal training materials (guides, presentations, job aids, FAQs)
• Deliver live and virtual training sessions to clients and internal stakeholders
• Assess training effectiveness and continuously improve learning materials and programs
• Support onboarding efforts for new clients through structured implementation and training programs
• Assist in the planning, scheduling, and facilitation of client meetings, including onboarding sessions, status updates, and training workshops
• Prepare clear agendas, presentations, and supporting documentation
• Document meeting outcomes, action items, and follow-ups
• Manage project expectations through regular client meetings, project status reports and maintaining a great relationship throughout the implementation life cycles
• Create and maintain comprehensive documentation, including SOPs, knowledge base articles, release notes, and troubleshooting guides
• Ensure documentation is clear, accurate, and accessible
• Maintain internal administrative and knowledge-based repositories to support team efficiency
• Contribute to continuous improvement of support workflows and processes

Client Success Specialist

Data Engineer

• Aligning future state enterprise information architecture with corporate strategy
• Collaborates with enterprise architects and solution architects
• Supports enterprise data architecture roadmap by managing architectural runway
• Provides data architecture thought leadership
• Establishes collaborative, cross-functional relationships