New

Medicare Advantage and DSNP Grievance Coordinator

Mass General Brigham Health Plan
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Nov 06, 2025
The incumbent will coordinate, process, and document all aspects of member grievances for the Medicare Advantage, Medicare Supplement, and DSNP lines of business. Responsible for documenting and owning the life cycle of all member grievances. This includes but is not limited to maintaining tracking information, working closely with internal and external stakeholders to quickly resolve cases, communicating orally and in writing to all involved parties during the grievance process, and compiling reports for analysis purposes. It also includes free-writing grievance resolution notices and must be able to do this accurately, concisely, and independently. Essential Functions -Handle a large volume of incoming grievances from receipt through resolution, ensuring that all grievances are resolved within contractual timeframes. -Document and track all grievances in the appropriate tracking systems, ensuring the quality and accuracy of work is exemplary. -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. -Assist in the preparation of reports to various stakeholders, provide feedback on ways in which reporting can be enhanced and improved. -Work independently with members on their grievances. Provide helpful and appropriate information on an ongoing basis to members as you resolve their issue. -Resolves payment issues, claims processing issues, and identifies system improvements which in turn will reduce provider appeals. Education Bachelor's Degree Related Field of Study required (experience can be substituted for degree) Experience At least 3-5 years of health plan experience, ideally within customer service, quality, or appeals and grievances area required At least 3-5 years of Medicare Advantage/DSNP grievance experience within a health plan highly preferred Knowledge, Skills, and Abilities Strong aptitude for technology-based solutions. Strong customer service skills. Excellent written communication skills. Ability to adapt to changing priorities and work effectively in a dynamic environment. Excellent organizational abilities to manage multiple tasks, prioritize work, and meet deadlines. Working Conditions This is a remote role that can be done from most US states Employees must use a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment. 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.