Appeals & Grievances 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 Appeals and Grievance Coordinator will coordinate, process, and document all aspects of member appeals and grievances, as well as provider appeals across all our product offerings (Commercial, Medicaid and Medicare).

This role will be responsible for documenting and guiding the life cycle of all member appeals and grievances and provider appeals. This includes, but is not limited to, maintaining tracking information, working closely with internal and external collaborators to quickly resolve cases, communicating orally and in writing to all involved parties during the appeals and grievances process, and compiling reports for analysis purposes.

The Grievance and Appeals Coordinator will also present cases to the Appeals Committee. Detailed knowledge of all applicable health plan policies and procedures, MassHealth, the Health Connector, DOI regulations, Medicare regulations and Commercial product contractual obligations is a key element of this role. Strong customer service and interpersonal skills during regular interactions with customers, providers, and external agencies.

Qualifications

Education

Bachelor's Degree Related Field of Study preferred

Can this role accept experience in lieu of a degree?

yes

Experience

Health plan experience, ideally within customer service, quality or appeals and grievances area. 3-5 years required

Knowledge, Skills and Abilities

• Superior verbal and written communication skills.
• Understanding of health plan operations, ideally in customer service and/or appeals and grievances.
• Proficient in Microsoft Excel and Word.
• Sensitive to confidential materials and the ability to maintain a professional demeanor in potentially difficult situations involving providers, members, and internal customers.
• Able to understand and adhere to sophisticated regulations.
• Demonstrate Mass General Brigham Health Plans core brand principles of always listening, challenging conventions, and providing value.
• Bring fresh ideas forward by listening to and working with employees and the people we serve.
• Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
• Strong, demonstrated track record of an ability to complete time, on budget, and on scope.
• Strong skills for technology-based solutions.
• Ability to inject energy, when and where it's needed.
• Current in healthcare trends.
• Proven forward, transformational thinking; ability to see "what is" and envision "what could be."
• Ability to develop, introduce, defend, and gain support for new insights and approaches.
• Excellent leadership skills and leadership track record.
• Ability to translate and communicate sophisticated topics in a variety of forums, tailoring communications to optimally fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.
• Ability to view the long-range trends and cycles of the business and industry and see the "big picture."
• Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
• Ability to challenge the status quo and drive innovative thinking and the capability to efficiently implement strategy.
• Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
• Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
  Unquestionable integrity.

Additional Job Details (if applicable)

Working Conditions

• While a remote role, this team meets every quarter at the office at Assembly Row in Somerville and attendance is highly encouraged.
• The typical schedule for this role is Monday through Friday role with a schedule of 8:30 to 5 PM EDT
• This role includes an on-call component where you would be on-call on weekends, roughly every 6 weeks

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$ $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 package. In 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.

EEO Statement:

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 Veteran's 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

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.