Director, Medicare Advantage and DSNP Claims

• Partner with the Sr. Director, Medicare Operations on the claims implementation of the Senior Care Options (SCO) and One Care products
• Oversee all aspects of the Medicare and DSNP Claims Department and ensure Compliance with CMS and EOHSS regulatory requirements.
• Monitor reporting of claim key metrics including but not limited to accuracy, timeliness, quality scores, and inventory.
• Align resources and delegate activities to accomplish key objectives; clearly convey and assign accountability for important objectives, deadlines, and expectations.
• Act as the key contact for internal and external customers regarding claim processing questions.
• Collaborate with other business areas such as Product, IT, Configuration, COB, and Member Call Center to meet objectives and address issues.
• Partner on resolving vendors claim processingquestions as needed
• Develop and mentor team in order to create a high-performance service culture aligned with the strategic goals, objectives, and core values of the organization.
• Oversee the development of P&Ps and Job Aids, and ensure staff training
• Ensure Quality results are reviewed with team members on a regular basis and retraining occurs as needed.
• Anticipate, and meet or exceed, internal and/or external customer expectations and requirements.

• Inform, engage, inspire, motivate, and actively listen to employees.
• Make decisions that put the needs of the people we serve-our members, providers, brokers, and employers-front and center.
• Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
• Identify/create processes and align resources to accomplish key objectives; clearly convey and assign accountability for important objectives, deadlines, and expectations.
• Hire, participate in, and/or recommend development measures and disciplinary actions up to and including termination; evaluate performance and supervise the work of all direct and indirect reports following established organizational policies, procedures, and practices.
• Set clear goals and objectives, use metrics to measure performance.
• Provide coaching to improve performance and holds regular development meetings.
• 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.
• Other duties as assigned with or without accommodation.

• Bachelor's degree required or the equivalent combination of training and 5+ years of experience.
• 5+ years of Medicare and/or DSNP claims leadership preferred.

Physical Requirements

• Standing Occasionally (3-33%)
• Walking Occasionally (3-33%)
• Sitting Constantly (67-100%)
• Lifting Occasionally (3-33%) 20lbs - 35lbs
• Carrying Occasionally (3-33%) 20lbs - 35lbs
• Pushing Rarely (Less than 2%)
• Pulling Rarely (Less than 2%)
• Climbing Rarely (Less than 2%)
• Balancing Occasionally (3-33%)
• Stooping Occasionally (3-33%)
• Kneeling Rarely (Less than 2%)
• Crouching Rarely (Less than 2%)
• Crawling Rarely (Less than 2%)
• Reaching Occasionally (3-33%)
• Gross Manipulation (Handling) Constantly (67-100%)
• Fine Manipulation (Fingering) Frequently (34-66%)
• Feeling Constantly (67-100%)
• Foot Use Rarely (Less than 2%)
• Vision - Far Constantly (67-100%)
• Vision - Near Constantly (67-100%)
• Talking Constantly (67-100%)
• Hearing Constantly (67-100%)