At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission—from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.
At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare — people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds – to apply.
Job Summary
The Director, Medicare and 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 Director will be responsible for overseeing the day-to-day, monthly, and annual activities of the products to meet CMS and EOHSS 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
Partner with the Sr. Director, Medicare Operations on the claims implementation of the Senior Care Options (SCO) and One Care productsOversee all aspects of the Medicare and DSNP Claims Department and ensure Compliance with CMS and EOHSS 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 claim processing questions.Collaborate with other business areas such as Product, IT, Configuration, COB, and Member Call Center to meet objectives and address issues.Partner on resolving vendors claim processing questions as neededDevelop and mentor team in order to create a high-performance service culture aligned with the strategic goals, objectives, and core values of the organization. Oversee the development of P&Ps and Job Aids, and ensure staff trainingEnsure 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. 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 holds regular development meetings.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.Other duties as assigned with or without accommodation. Bachelor’s degree required or the equivalent combination of training and 5+ years of experience.5+ years of Medicare and/or DSNP claims leadership preferred.
Additional Job Details (if applicable)
Physical Requirements
Standing Occasionally (3-33%)Walking Occasionally (3-33%)Sitting Constantly (67-100%)Lifting Occasionally (3-33%) 20lbs - 35lbsCarrying Occasionally (3-33%) 20lbs - 35lbsPushing Rarely (Less than 2%)Pulling Rarely (Less than 2%)Climbing Rarely (Less than 2%)Balancing Occasionally (3-33%)Stooping Occasionally (3-33%)Kneeling Rarely (Less than 2%)Crouching Rarely (Less than 2%)Crawling Rarely (Less than 2%)Reaching Occasionally (3-33%)Gross Manipulation (Handling) Constantly (67-100%)Fine Manipulation (Fingering) Frequently (34-66%)Feeling Constantly (67-100%)Foot Use Rarely (Less than 2%)Vision - Far Constantly (67-100%)Vision - Near Constantly (67-100%)Talking Constantly (67-100%)Hearing Constantly (67-100%)
Remote Type
Hybrid
Work Location
399 Revolution Drive
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
EEO Statement:
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.
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.