Member Advocacy 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 Member Advocacy Coordinator serves as a dedicated quality research and investigative resource within the Customer Service department. This role oversees oral dissatisfaction coverage determination and organization determination (ODAG) and service recovery cases from intake to ensure proper intake is adequate for first-call resolution or that additional information is required to update and route to the appropriate department for resolution. The coordinator conducts case research reviews member interactions and documentation identifies trends and opportunities for process improvement and partners with leadership to improve the member experience quality and compliance. The role primarily focuses on investigation and on coordinating cross-functional communication between Health Plan departments to ensure accurate issue resolution.

Essential Functions
-Handle a high volume of Oral Dissatisfaction Appeals and Grievance (ODAG) cases from verbal intake through resolution conducting research and investigation as needed to ensure concerns are appropriately addressed or routed to the correct department for resolution.
-Ensure accurate documentation timely follow-up and compliance with contractual and regulatory turnaround time requirements for member communications.
-Review triage and route ODAG cases within designated tracking systems ensuring all work is completed with a high degree of accuracy quality and attention to detail. Maintain comprehensive case documentation including detailed ODAG notes research findings member outreach efforts resolution activities and all supporting information necessary to support effective case management regulatory compliance and timely resolution.
-Assist in communicating and escalating member and provider feedback to appropriate stakeholders including Appeals & Grievances Provider Appeals Operations and other business areas. Analyze recurring themes and trends and provide recommendations to enhance reporting strengthen operational insights and improve processes service delivery and member experience outcomes.
-Prepare and maintain case files for CMS HPMS and other high-priority escalations ensuring all supporting documentation research and responses are complete accurate and submitted within established regulatory and contractual deadlines.
-Provide members with helpful appropriate information on an ongoing basis as you resolve their issues.
-Coordinates with appropriate departments to resolve payment and claims processing issues and to identify system improvements that will in turn reduce member appeals. <

Education
High School Diploma or Equivalent required and Associates Degree Related Field of Study preferred

Experience
Health plan experience ideally within customer service quality or appeals and grievances area 3-5 years required and Administrative experience 2-3 years preferred and Billing and Claims experience 2-3 years preferred

Knowledge Skills and Abilities
- Strong aptitude for technology-based solutions.
- Strong customer service skills.
- Excellent 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.

M-F 8 AM - 5 PM EST hours required for remote role
A quiet secure stable HIPPA-compliant workstation is required.

Remote

399 Revolution Drive

40

Regular

Day (United States of America)

Pay Range

$22.22 - $31.71/Hourly

Grade

4

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.

8925 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 .