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Job Summary
The Manager, DSNP (Senior Care Options and One Care) Claims, will partner cross-functionally on the Senior Care Options and One Care implementation and testing activities. The Manager will be responsible for managing the day-to-day, monthly, and annual activities of the products to meet CMS and EOHHS regulatory requirements. This includes responsibility for monitoring accuracy and timeliness, forecasting, training and evaluating. The successful candidate will be an active participant on cross-functional teams to address strategic business initiatives and be a resource for both internal and external business partners.
Qualifications
Principal Duties and Responsibilities:
Partner with the Director, Medicare Advantage and DSNP Claims on the claims implementation of the Senior Care Options (SCO) and One Care products
Manage all aspects of the DSNP Claims Department and ensure Compliance with CMS and EOHHS regulatory requirements.
Monitor reporting of claim key metrics including but not limited to accuracy, timeliness, quality scores, and inventory.
Align resources and delegate activities to accomplish key objectives; clearly convey and assign accountability for important objectives, deadlines, and expectations.
Act as the key contact for internal and external customers regarding Senior Care Options (SCO) and One Care claim processing questions.
Collaborate with other business areas such as Product, IT, Benefit Administration, Configuration, COB, and Member Call Center to meet objectives and address issues.
Collaborate with vendors that impact claim processing
Develop and mentor team in order to create a high-performance service culture aligned with the strategic goals, objectives, and core values of the organization.
Research and resolve issues and escalate as needed.
Develop and review P&Ps and Job Aids
Oversee staff training to ensure all department policies and procedures are consistently applied.
Ensure Quality results are reviewed with team members on a regular basis and retraining occurs as needed.
Anticipate, and meet or exceed, internal and/or external customer expectations and requirements.
Management Responsibilities:
Inform, engage, inspire, motivate, and actively listen to employees.
Make decisions that put the needs of the people we serve—our members, providers, brokers, and employers—front and center.
Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
Identify/create processes and align resources to accomplish key objectives; clearly convey and assign accountability for important objectives, deadlines, and expectations.
Hire, participate in, and/or recommend development measures and disciplinary actions up to and including termination; evaluate performance and supervise the work of all direct and indirect reports following established organizational policies, procedures, and practices.
Set clear goals and objectives, use metrics to measure performance.
Provide coaching to improve performance and hold regular development meetings.
Hold self and others accountable to meet commitments.
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.
Other duties as assigned with or without accommodation.
Qualifications:
Bachelor’s degree or the equivalent combination of training and 5+ years of experience.
3+ years of Medicare and/or DSNP claims leadership preferred.
Skills/Abilities/Competencies:
Demonstrate Mass General Brigham Health Plan's 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.
Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
Strong aptitude for technology-based solutions.
Ability to inject energy, when and where it’s needed.
Current in healthcare trends.
Demonstrated forward, visionary thinking; ability to see “what is” and envision “what could be.”
Ability to develop, introduce, defend, and gain support for new ideas and approaches.
Excellent leadership skills and leadership track record.
Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills are 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 successfully 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.
Supervisory Responsibilities:
Motivate and encourage staff; lead through change. Make decisions as needed and build consensus as appropriate. Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
Set clear goals and objectives and use metrics to measure performance and hold staff accountable. Provide coaching to improve performance; hold regular development discussions with direct reports. Recognize staff for their contributions.
Inform, engage, inspire, motivate, and actively listen to employees.
Make decisions that put the needs of the people we serve—our members, providers, brokers, and employers—front and center.
Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
Identify/create processes and align resources to accomplish key objectives; clearly convey and assign accountability for important objectives, deadlines, and expectations.
Hire, participate in, and/or recommend development measures and disciplinary actions up to and including termination; evaluate performance and supervise the work of all direct and indirect reports following established organizational policies, procedures, and practices.
Set clear goals and objectives, use metrics to measure performance, and hold employees accountable. Provide coaching to improve performance and holds regular development meetings.
Additional Job Details (if applicable)
Working Conditions:
This is a hybrid role with onsite meetings at the office in Assembly Row, Somerville 2x/month but we would consider remote candidates
Remote Type
Hybrid
Work Location
399 Revolution Drive
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
Pay Range
$97,510.40 - $141,804.00/Annual
Grade
8
EEO Statement:
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 (857)-282-7642.
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.