Hold self and others accountable to meet commitments. Ensure diversity, equity, and inclusion are integrated as a guiding principle. Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise. Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people first organization.

Deep understanding of Medicare products and CMS rules and regulations governing those products. Ability to lead cross functional teams, drive decision making and ensure end to end operational integrity of product implementations and/or product enhancements Drives secondary research and qualitative and quantitative analysis to inform product design and development Assists

Assist with monthly general ledger close, reporting, and general ledger account reconciliations. Deliver timely and accurate financial reporting data to internal and external customers while successfully executing on financial reporting controls. Monitor executing and documenting key controls and policies & procedures, including, but not limited to regulatory filings, man

The Sr. Claims Auditor utilizes CPT and ICD 10 coding to review physician claims and medical records for coding accuracy. Internal auditing functions focus on "desktop reviews" of claims, design and quality control of future audits, and other auditing related functions. Review clinical notes and claims submitted to verify the appropriateness of codes billed based on servi

Provides administrative support to the President, Chief of Staff & Vice President of Corporate Services, and Manager of Program and Administration. Serves as the face of the President's office and professionally represents the President's office when greeting clients and others Manages interdepartmental scheduling for the President and the Chief of Staff & Vice President

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable

Under the guidance of the Director, evaluate, negotiate and recommend changes to new and existing contracts to ensure that MGBHP preferred terms are included. Act as resource for internal staff when consultant, business associate and nondisclosure agreements are required. Develop strong relationships with vendor partners. Drive continuous improvement in all aspects of the

Handle a large volume of incoming grievance and appeals from receipt through resolution, ensuring that all appeals are resolved within contractual timeframes. Ensure accurate time management of all work, ensuring results are met on time and to the best of your ability. Document and supervise all appeals and grievances in the appropriate tracking systems, ensuring the qual

Ensures Medicare Advantage CSP guidelines and compliance with CMS regulations Identify trends within the Medicare Advantage team Provide daily direction to team members and ensure their awareness and understanding of information necessary such that calls are answered in a timely, efficient, and knowledgeable manner. Handle all complex customer requests and service failure