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...

Senior Manager Appeals & Grievances
Boston, MA
Establish framework and manage performance for the Appeals and Grievance team aligned with objective to provide best in class service Prioritize and vet a focused set of key performance...

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...

Clinical Support Coordinator
Somerville, MA
This is a remote role with occasional (roughly 1x/every other month) onsite team meetings in Somerville, MA. Mass General Brigham Health Plan is an exciting place to be within the health...

Medicare Advantage Project Coordinator (Remote)
Somerville, MA
Works with the Director, Medicare Advantage Program and Innovation Operations, and health plan business areas/departments to execute the annual Medicare Advantage work plan which include...

Customer Service Professional
Somerville, MA
Serve as the primary liaison for members and providers for all lines of business including MassHealth, and Commercial members regarding general program inquires such as eligibility verif...

Senior Actuarial Analyst
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...

Claims Resolutions Coordinator
Somerville, MA
Review and research assigned claims by navigating multiple systems and platforms and accurately capturing the data/information necessary for processing (e.g., verify pricing/Fee Schedule...

Senior Information Management Developer
Somerville, MA
Information Management Developer Leads analysis, design, development, and testing of operational and regulatory reporting for Medicare and Medicaid lines of business. Produces data sets...

Sr. Data Analyst
Somerville, MA
Evaluate and analyze data using T SQL, Excel, and PowerBI and other BI tools to design, develop, and test analytic solutions from various data sources. Analyze, Interpret, and validate r...

Reconciliation Program Manager
Somerville, MA
Responsible for ensuring all 834 transactions are being correctly reconciled. Work closely with IT to set requirements and user stories, as well as signing off on results and approving c...

Actuarial Analyst II
Somerville, MA
Leads reserving analysis and communication of financial results to senior leadership. Responsible for developing monthly IBNR, reviewing claims projects, updating lag files, and supporti...

Medical Letter Writer
Somerville, MA
This is a remote role with occasional (roughly 1x/every other month) onsite team meetings in Somerville, MA. Mass General Brigham Health Plan is an exciting place to be within the health...