Mass General Brigham Health Plan
Six major aims for care
Mass General Brigham Health Plan believes that quality care should be:
- Safe: Care that is intended to help patients should not injure them.
- Effective: Services should be based on scientific knowledge and given to all who could benefit. Care should not be used when it will not be beneficial. Effective care should be precise: services should not be overused or underused.
- Patient-centered: Care should be respectful and responsive to individual patient preferences, needs, and values.
- Timely: Access to care should not take longer than necessary. Patients should not have to wait unless it will provide information or time to heal. Prompt attention benefits both the patient and the caregiver.
- Efficient: Effective care should minimize waste — and cost — of supplies, equipment, space, capital, ideas, time, and opportunities.
- Equitable: Everyone should have access to high quality care, regardless of their race, ethnicity, gender, or income.
Our mission and vision
Our vision is to help create a world in which all people live healthier lives. We strive to create a better health system by removing barriers, providing no-nonsense solutions, innovating through partnerships, and delivering compassionate experiences.About Mass General Brigham
From the hospital to home, our integrated health system offers high-quality care in every part of the health journey. For more information, please visit massgeneralbrigham.org.Search among Mass General Brigham Health Plan jobs
| Jobs: 1 - 10 of 16 |
Somerville, Massachusetts
Mass General Brigham Health Plan
Responsible for processing and managing member enrollments, ensuring accuracy and adherence to regulatory requirements for Medicare lines of business. Essential Functions -Process new member enrollments, ensuring all required documents are ...
22h
| Job Type | Full Time |
Claims Review Specialist, DSNP
Somerville, Massachusetts
Mass General Brigham Health Plan
The DSNP Claims Review Specialist reviews and processes Senior Care Options (SCO) and One Care medical claims requiring manual intervention when autoadjudication is not achieved. The Specialist ensures claims are adjudicated accurately, tim...
22h
| Job Type | Full Time |
Somerville, Massachusetts
Mass General Brigham Health Plan
The role is an integral part of our Appeals and Grievance review process and will ensure clinical/pharmacy appeal case reviews meet contractual, regulatory, and business goals. The position collaborates with members of the Appeal and Grieva...
2d
| Job Type | Full Time |
Regulatory Affairs and Compliance Manager
Somerville, Massachusetts
Mass General Brigham Health Plan
Responsible for ensuring that Mass General Brigham Health Plan's commercial line of business adheres to all applicable federal and state regulatory requirements and industry standards. This role manages regulatory submissions, supports audi...
2d
| Job Type | Full Time |
Somerville, Massachusetts
Mass General Brigham Health Plan
The role is responsible for investigating potential recoveries for Coordination of Benefits through phone calls, questionnaires, claims, provider inquiries, and other systems as required. This incumbent will also be responsible for the mana...
8d
| Job Type | Full Time |
Affordability and Product Innovation Lead
Somerville, Massachusetts
Mass General Brigham Health Plan
Reporting to the Director of Strategy, Dual Eligible Programs, and working cross-functionally with Clinical leadership, this role is responsible for two key functions at the health plan. First, this role is responsible for leading MGB Healt...
10d
| Job Type | Full Time |
DSNP MassHealth Eligibility Representative
Somerville, Massachusetts
Mass General Brigham Health Plan
Responsible for outreaching to Dual Eligible prospects to assist them with the Medicaid Enrollment process from start to finish, as well as provide Medicare Enrollment guidance. This position is responsible for monitoring and optimizing pro...
13d
| Job Type | Full Time |
Medicare Advantage Claims Quality Control Reviewer
Somerville, Massachusetts
Mass General Brigham Health Plan
Responsible for monitoring Quality Control (QC) of Claims Operations and the reporting of all metrics related to such activities. Essential Functions - Responsible for end-to-end pre-pay review of claims adjudicated in QNXT to ensure comple...
13d
| Job Type | Full Time |
Dual Eligible Program Inside Sales Rep
Somerville, Massachusetts
Mass General Brigham Health Plan
Responsible for engaging prospective and existing customers through inbound and outbound communications, identifying their insurance needs, and recommending tailored solutions that align with our product offerings. Essential Functions -Cond...
17d
| Job Type | Full Time |
Somerville, Massachusetts
Mass General Brigham Health Plan
The EPIC EDI Developer is an experienced developer with the capability to work on and provide technical leadership for small to mediumsized projects from an implementation perspective. The role is responsible for designing and developing ED...
21d
| Job Type | Full Time |