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HealthfirstHE

PDO Operations Analyst

Healthfirst is a not-for-profit health insurer based in New York, providing a range of affordable health plans and emphasizing community health.

Healthfirst

Employee count: 1001-5000

Salary: 51k-75k USD

United States only

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The Operations Analyst – Optimization Team is responsible for driving efficiency, accuracy, and continuous improvement across provider data operations. This role analyzes workflows, identifies inconsistencies, supports cross-functional collaboration, and implements scalable solutions to enhance onboarding, reconciliation, and overall operational performance.
The ideal candidate is analytical, detail-oriented, and proactive, with strong communication skills and the ability to translate data insights into actionable process improvements.

Key Responsibilities

Operational Optimization

  • Analyze provider data workflows to identify inefficiencies, rework, and process gaps.
  • Recommend and implement scalable solutions to improve turnaround times and reduce manual effort.
  • Support initiatives focused on operational excellence and continuous improvement.

Data Accuracy & Reconciliation

  • Perform reconciliation of provider data across systems (e.g., PDM, Atlas, MHS, HRP).
  • Identify discrepancies, conduct root-cause analysis, and partner with stakeholders to resolve issues.
  • Ensure data integrity, consistency, and alignment across platforms.

QA / UAT & Quality Initiatives

  • Participate in QA and UAT testing to validate provider data accuracy and system enhancements.
  • Document findings and support issue resolution prior to production deployment.

Reporting & Data Insights

  • Analyze provider data trends and develop insights to support informed decision-making.
  • Prepare reports and dashboards highlighting risks, performance metrics, and improvement opportunities.

Training & Documentation

  • Develop and maintain job aids, standard operating procedures, and training materials.
  • Support knowledge-sharing initiatives to improve consistency and team effectiveness.

Minimum Qualifications

  • High School Diploma or GED from an accredited institution required; Associate’s or Bachelor’s degree in Business, Healthcare Administration, Data Analytics, or related field preferred.
  • Experience working in Microsoft product suite, including Outlook, Word, PowerPoint and Excel
  • Advanced Excel skills, including the ability to manipulate and create spreadsheets; standardize reports across multiple worksheets; utilize VLOOKUPs, XLOOKUPs, formulas, and functions; create, interpret, and analyze pivot tables; and apply filtering, conditional formatting, and data validation techniques to generate accurate and meaningful results.

Preferred Qualifications

  • Bachelor’s degree in Business, Healthcare Administration, Data Analytics, or related field (or equivalent experience).
  • 2–4+ years of experience in healthcare operations, provider data management, or process optimization.
  • Experience analyzing data trends and identifying inconsistencies or discrepancies across systems.
  • Ability to perform data reconciliation and root-cause analysis to resolve operational issues
  • Experience working in cross-functional environments and collaborating with multiple stakeholders.
  • Strong written and verbal communication skills, including the ability to document processes and present findings clearly.
  • Ability to manage multiple priorities in a fast-paced environment.
  • Experience in managed care or provider network operations.
  • Familiarity with PDM, provider onboarding workflows, or credentialing processes.
  • Experience supporting QA/UAT testing initiatives.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLCshallnotdiscriminateagainstanydisabledemployeeorapplicantinregard to any position for which the employee or applicant is otherwise qualified.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC.

Know Your Rights

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

  • Greater New York City Area (NY, NJ, CT residents): $58,900 - $80,070

  • All Other Locations (within approved locations): $51,000 - $74,880

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

About the job

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Posted on

Job type

Full Time

Experience level

Salary

Salary: 51k-75k USD

Education

High school

Location requirements

Hiring timezones

United States +/- 0 hours

About Healthfirst

Learn more about Healthfirst and their company culture.

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Healthfirst has been a dedicated partner in providing affordable healthcare solutions to New Yorkers for over 30 years. Founded by a coalition of leading hospitals, we have created a model that focuses on transitioning the healthcare system towards value-based care—where the quality of care is prioritized over volume. Our extensive network includes nearly 2 million members across New York City and beyond, encompassing a variety of products such as Medicaid, Medicare Advantage, Child Health Plus, and Essential Plans. With a commitment to enhancing healthcare access and outcomes, we offer comprehensive services that include individualized care coordination, tailored health plans for all ages, and many community health initiatives.

At Healthfirst, we place significant emphasis on community engagement, driving efforts to partner with local organizations to ensure that healthcare reaches those who need it most. Our dedicated workforce is more than just an insurance provider; we serve as proactive allies in the health journey of our members. This includes providing essential resources for managing long-term health conditions, access to necessary screenings, and supportive services that encourage healthy lifestyles. As part of our mission, we actively seek to eliminate barriers to healthcare, ensuring every member can access the benefits and services they deserve, thereby promoting overall wellness and longevity in the communities we serve.

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