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

This position is responsible for monitoring and optimizing processes related to Medicare Advantage and D-SNP Enrollment.

Duties and Responsibilities:

-Monitor and analyze Medicare Advantage and D-SNP Enrollment operations to ensure timeliness, accuracy and compliance internally.  Collaborate with  vendor partners to monitor and analyze enrollment reporting.
-Review, track, and communicate key performance indicators (KPIs) related to compliance, timeliness, and accuracy.
-Work closely with internal departments, including but not limited to Sales, Finance, Customer Service, Claims, IT, Product, Marketing, STARS leadership, and Digital Services to ensure seamless coordination and integration of enrollment operations.
-Identify operational inefficiencies or process bottlenecks and recommend improvements to enhance workflows, reduce costs, and improve member satisfaction.
-Assist with the implementation and management of new health plan products or changes to existing plans.
-Support the creation and maintenance of health plan policies, procedures, and workflows to ensure compliance with CMS and EOHHS regulatory requirements.
-Provide audit support, both internal and external, and support the monthly Enrollment Data Validation (EDV) and Residence Address Change (RAC) processes for all contracts.
-Create and update Enrollment and Premium Billing reports.  Identify trends, recommend actions, and escalate to leaders as appropriate.
-Performs other duties as assigned
-Complies with all policies and standards

 

Qualifications

Qualifications

Bachelor’s Degree required; experience can be substituted for years of experienceAt least 2-3 years of health Insurance or Healthcare Industry experience requiredMedicare experience preferred.Massachusetts Medicaid experience preferred.  

 

 

Additional Job Details (if applicable)

Working Conditions

This is a remote role that can be done from most US states

 

Remote Type

Remote

 

Work Location

399 Revolution Drive

 

Scheduled Weekly Hours

40

 

Employee Type

Regular

 

Work Shift

Day (United States of America)

 

Pay Range

$62,400.00 - $90,750.40/Annual

 

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:

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.

 

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.