Medicare Advantage and DSNP Grievance Coordinator presso Massgeneralbrigham
Massgeneralbrigham · Somerville, Stati Uniti d'America · Remote
- Professional
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 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.
Qualifications
Education
- Bachelor's 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.
Additional Job Details (if applicable)
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 Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$30.00 - $43.63/Hourly
Grade
6
EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
