Medicare Advantage and DSNP Grievance Coordinator

Site: Mass General Brigham Health Plan Holding Company Inc.

Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

The incumbent will coordinate process and document all aspects of member grievances for the Medicare Advantage Medicare Supplement and DSNP lines of business. Responsible for documenting and owning the life cycle of all Medicare Part C member grievances. This includes but is not limited to maintaining tracking information working closely with internal and external stakeholders to quickly resolve cases communicating orally and in writing to all involved parties during the grievance process and compiling reports for analysis purposes. It also includes free-writing grievance resolution notices and must be able to do this accurately concisely and independently.

Essential Functions
-Handle a large volume of incoming grievances from receipt through resolution ensuring that all grievances are resolved within contractual timeframes.
-Document and track all grievances in the appropriate tracking systems ensuring the quality and accuracy of work is exemplary.
-Ensure grievance files are complete and contain all relevant documentation including research materials acknowledgment and resolution letters and any other pertinent information related to the case.
-Assist in the preparation of reports to various stakeholders provide feedback on ways in which reporting can be enhanced and improved.
-Work independently with members on their grievances. Provide helpful and appropriate information on an ongoing basis to members as you resolve their issue.
-Resolves payment issues claims processing issues and identifies system improvements which in turn will reduce provider appeals.

Education

• Bachelors Degree Related Field of Study required (experience can be substituted for degree)

Experience

• At least 3-5 years of health plan experience ideally within customer service quality or appeals and grievances area required
• At least 3-5 years of Medicare Advantage/DSNP grievance experience within a health plan highly preferred

Knowledge Skills and Abilities

• Strong aptitude for technology-based solutions.
• Strong customer service skills.
• Excellent written communication skills.
• Ability to adapt to changing priorities and work effectively in a dynamic environment.
• Excellent organizational abilities to manage multiple tasks prioritize work and meet deadlines.

Working Conditions

• This is a remote role that can be done from most US states
• Employees must use a stable secure and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment.

Remote

399 Revolution Drive

40

Regular

Day (United States of America)

Pay Range

$30.00 - $43.63/Hourly

Grade

6

At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

Mass General Brigham Health Plan Holding Company Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .

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