Medical Director, Medicare and Special Investigations Unit
Somerville, MA
Act as expert medical advisor for Medicare related activities Provide Clinical oversight and leadership for the Medicare Advantage line of business Lead the Medicare Advantage Utilizatio...

COB Verification Representative
Somerville, MA
Responsible for identifying recovery opportunities within the COB/TPL Department. Review, research and process all COB claims for members with other insurance, including retractions, rep...

Marketing Traffic Manager
Boston, MA
This is a remote role and can be done from most US states. Join the Mass General Brigham Health Plan team and bring your unique talents to our diverse community and challenge the health...

Actuarial Lead
Somerville, MA
Supports reserving analysis and communication of financial results to senior leadership. Responsible for monthly IBNR and other actuarial accruals (MLR Rebate, risk adjustment, PDR, Prov...

Project Manager
Boston, MA
Lead and consult project teams throughout all phases of the Project lifecycle Initiation, Planning, Execution and Closure, ensuring appropriate transitions and results monitoring are in...

Senior Vice President, State Programs - Mass General Brigham Health Plan
Somerville, MA
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...

Medicare Advantage Customer Service Manager
Somerville, MA
Act as a key advocate for customer service excellence within the Customer Service Center and across the organization. Provide leadership, development and mentoring of the supervisors and...

Medicare Advantage Provider Engagement Manager
Somerville, MA
Strategic Provider Relationship management o Proactive approach to relationships o Creating an annual plan for engagement across all network providers o Support field sales executives o...

Deputy Chief Medical Officer, Mass General Brigham Health Plan
Somerville, MA
Plan, direct, coordinate and communicate all the medical strategies, standards for care, and policies of the organization and develop policies and procedures relative to practices. Provi...

Clinical Appeals and Grievances Nurse
Boston, MA
Analyze and complete written summaries on clinical cases. Maintain compliance with all required turnaround times Maintain compliance with all regulatory and NCQA requirements with regard...

Appeals and Grievances Coordinator
Boston, MA
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 manage...

Clinical Quality Compliance Specialist
Boston, MA
Review daily, weekly, monthly, quarterly, and yearly CDAG and ODAG reporting to ensure compliance with all Centers for Medicare and Medicaid (CMS) requirements. Develop and maintain CDAG...

Risk Adjustment Coding Coordinator
Somerville, MA
Leadership Impact & Problem Solving Actively contributes to the strategic direction for Risk Coding and collaborates with vendor partners to lead volume and ensure adherence to agree upo...

Sr. Regulatory Affairs Manager
Somerville, MA
Lead the management of a portfolio of federal regulations, inclusive of policy development, external advocacy work, and gathering internal feedback in support of the advocacy work. Serve...

Claims Team Lead
Somerville, MA
Manage and distribute work as designated Run and analyze reports Review aging and inventory levels Hold self and others accountable to meet commitments Assist in testing new processes, s...