Duals Supervisor, Appeals And Grievances

Mass General Brigham Health Plan Holding Company, Inc.

Somerville, MA, United States
Base: $79,560.00 - $115,720.80/annual; bonus/equit...
Fully remote
3-5 years billing claims or appeals management experience
1-2 years supervisory or leadership role experience
Knowledge of massachusetts division of insurance requirements
The role provides day-to-day supervision of a team responsible for the duals line of business and appeals and grievance processes

Job Summary

  • The role provides day-to-day supervision of a team responsible for the duals line of business and appeals and grievance processes.
  • Candidates must ensure compliance with regulations from the Massachusetts Division of Insurance, EOHHS, CMS, and NCQA while leading operational efficiency.
  • The position offers competitive salaries, flexible work options, and career growth opportunities within a not-for-profit healthcare system.

Matching Summary

The role provides day-to-day supervision of a team responsible for the duals line of business and appeals and grievance processes.

Salary

Base: $79,560.00 - $115,720.80/Annual; Bonus/Equity: Not specified; Benefits: Comprehensive benefits package including flexible work options and career growth

Skills & Requirements

Must-have

  • 3-5 years billing claims or appeals management experience
  • 1-2 years supervisory or leadership role experience
  • Knowledge of Massachusetts Division of Insurance requirements
  • Experience with CMS and NCQA guidelines
  • Ability to coordinate cross-functional teams

Nice-to-have

  • 5-7 years health plan operations experience
  • 2-3 years Medicare Dual Special Needs Programs experience
  • Experience developing training curriculum
  • Strong relationship building skills
  • Proven track record in quality control processes

Key Requirements

  • Associate's degree required
  • 3-5 years billing, claims, or appeals management experience
  • 1-2 years supervisory or leadership experience preferred
  • 5-7 years health plan operations experience highly preferred
  • 2-3 years Medicare/Dual Special Needs Programs experience highly preferred

Work Rights

Not specified

Tailored Resume

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