Medicare Grievance Coordinator

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 world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience – a commitment that starts with our employees.

We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.

The Grievance Coordinator will coordinate, process, investigate, and document all aspects of member complaints and grievances across our Medicare line of business.

This role will be responsible for documenting and guiding the life cycle of all member grievances. This includes, but is not limited to, maintaining tracking information, working closely with internal stakeholders and external vendors/partners to quickly resolve cases. The Coordinator will communicate orally and/or in writing to all involved parties during the grievance process and document according to established standards for reporting and analysis purposes.

The Coordinator must have detailed knowledge of all applicable health plan policies and procedures. Regulatory (CMS, DOI, Mass Health) and contractual requirement knowledge and expertise are key elements of this role. Strong customer service and interpersonal skills are mandatory during regular interactions with customers, providers, and external agencies.

• Handle a large volume of incoming grievances (both formal and informal) from receipt through resolution, ensuring that all grievances are resolved within contractual and regulatory time frames and that all work is completed on time with high quality.
• Document and supervise all grievances in the appropriate tracking systems, ensuring the highest quality and accuracy of work.
• Ensure grievance files are complete and contain all relevant documentation, including research materials, acknowledgment and resolution letters, and any other pertinent information related to the case.
• Collaborate with key departments on all grievances, including Compliance, Pharmacy, Medical Directors, Sales, and other relevant senior and executive staff.
• Assist with or lead external grievance investigations from regulatory agencies, including CMS, EOHHS, and the Division of Insurance.
• Assist with preparing formal written responses to external regulators.
• Work independently with members on their grievances, providing effective and appropriate information on an ongoing basis.
• Aid in the preparation of reports to various collaborators and provide feedback on ways in which reporting can be enhanced and improved.
• Stay ahead of changes to health plan policies and procedures and work closely with key partners to ensure that the files prepared for external agencies are accurate, well‑written, and meet the needs of all parties. Participate in team meetings and other development work, ensuring that information is presented accurately and your contribution to any development project is notable.
• Participate in internal and external audits and be receptive to any feedback and training offered.
• Function and excel in a remote environment, handling time‑critical appeals and grievance cases.
• Hold self and others accountable to meet commitments.
• Persist in accomplishing objectives to consistently achieve results despite obstacles and setbacks.
• Build positive 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 preferred

• At least 3‑5 years of health plan experience, ideally within customer service, quality, or appeals and grievances areas.
• Experience leading appeals and grievances for Medicare products and plans is highly preferred.
• Bilingual a plus.

• Strong aptitude for technology‑based solutions.
• Strong customer service skills.
• Excellent…