Appeals and Grievances Quality Assurance Auditor
HealthfirstUnited States
Posted April 13, 2026
58800 - 80070 USD
Full Time
About the Company
Healthfirst believes that every New Yorker deserves access to the best available healthcare. As one of New York’s highest quality not-for-profit health insurers serving close to two million New Yorkers, we make this a reality for our members. Founded more than 30 years ago by the leading hospital systems in downstate New York, Healthfirst established a partnership model that enables hospitals, health systems, and physicians in our network to prioritize health outcomes over profits, placing the needs of our members and community first. Healthfirst serves members in New York City, on Long Island, and in Westchester, Rockland, Sullivan, and Orange counties, offering market-leading products to suit every life stage. Our offerings include Medicaid plans, Medicare Advantage plans, Child Health Plus plans, Essential Plans, Long-Term Care plans, and Qualified Health plans. For more information on Healthfirst, please visit healthfirst.org.
Job Description
The Quality Assurance Auditor is responsible for performing Internal Quality Assurance Audits of Operational processes to ensure compliance with policies, procedures, and quality standards. The incumbent will investigate, audit, conduct root cause analysis, handle processing of determinations, track and trend findings.
Requirements
- Experience with the investigation, resolution, and reporting of appeal and grievance processes
- Experience in Microsoft Office suite of applications including Excel, Word, and PowerPoint
- High School Diploma or GED from an accredited institution
Benefits
- Medical, dental, and vision coverage
- Incentive and recognition programs
- Life insurance
- 401k contributions
