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 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

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 changes being promoted to production. Lead teams to enable system automation in Enrollment to reduce administrative costs, improve member experience and operational efficiency. Engage, empo

Leads reserving analysis and communication of financial results to senior leadership. Responsible for developing monthly IBNR, reviewing claims projects, updating lag files, and supporting of other actuarial accruals (MLR Rebate, MassHealth Corridors and Settlements, Risk Adjustment, Cost Sharing Reduction Accrual, etc.) Supports the quarterly forecasting of Mass General

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 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

This is a hybrid role that will require an onsite presence to the office 1x/month 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 sol

Responsible for all journal entries, monthly account reconciliations, and transactions for assigned accounts. Responsible for the timely creation and verification of monthly general ledger entries. Manages MassHealth Accountable Care Organization transactions and reporting. Works with senior finance staff to review financial documents and perform income and expense analys

Execute internal auditing and quality monitoring for daily, monthly, and annual transactions related to beneficiary, enrollment/disenrollment, membership benefit status and premium payment reconciliation. Develop subject matter expertise of complex Medicare/Medicaid program eligibility, and train others as needed. This will include developing and managing a quality assura

Hold self and others accountable to meet commitments. Ensure diversity, equity, and inclusion are integrated as a guiding principle. Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise. Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people first organization.

For over 30 years, AllWays Health Partners has delivered value to our members and worked to improve access to care and coverage. As a member of Mass General Brigham, AllWays is a health plan at the forefront of innovation, advancing a highly integrated model of value based care with one of the world's leading health care systems. Together, we are transforming the customer

Supervise the Claims Review Team in compliance with Mass General Brigham Health Plan's policies and procedures including Train, motivate, develop and evaluate staff in compliance with established policies, practices and procedures. Set and approve work schedules, time off requests, overtime and approve timecards. Schedule staff for needed training and development. Mentor

Deep understanding of Medicare products and CMS rules and regulations governing those products. Ability to lead cross functional teams, drive decision making and ensure end to end operational integrity of product implementations and/or product enhancements Drives secondary research and qualitative and quantitative analysis to inform product design and development Assists

Responsible for managing municipal and labor related activities for Mass General Brigham Health Plan. The scope of this position encompasses strategic growth plans for the municipal and labor market. Including broker/consultant relationship management, Chapter 32B municipal processes and procedures, product development and placement for active and retirees. Strong underwr

Assist with monthly general ledger close, reporting, and general ledger account reconciliations. Deliver timely and accurate financial reporting data to internal and external customers while successfully executing on financial reporting controls. Monitor executing and documenting key controls and policies & procedures, including, but not limited to regulatory filings, man

The Sr. Claims Auditor utilizes CPT and ICD 10 coding to review physician claims and medical records for coding accuracy. Internal auditing functions focus on "desktop reviews" of claims, design and quality control of future audits, and other auditing related functions. Review clinical notes and claims submitted to verify the appropriateness of codes billed based on servi

Provides administrative support to the President, Chief of Staff & Vice President of Corporate Services, and Manager of Program and Administration. Serves as the face of the President's office and professionally represents the President's office when greeting clients and others Manages interdepartmental scheduling for the President and the Chief of Staff & Vice President