Manager, DSNP (Senior Care Options and One Care) Claims

• Partner with the Director, Medicare Advantage and DSNP Claims on the claims implementation of the Senior Care Options (SCO) and One Care products

• Manage all aspects of the DSNP Claims Department and ensure Compliance with CMS and EOHHS 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 Senior Care Options (SCO) and One Care claim processing questions.

• Collaborate with other business areas such as Product, IT, Benefit Administration, Configuration, COB, and Member Call Center to meet objectives and address issues.

• Collaborate with vendors that impact claim processing

• 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.

• Research and resolve issues and escalate as needed.

• Develop and review P&Ps and Job Aids

• Oversee staff training to ensure all department policies and procedures are consistently applied.

• 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.

Management Responsibilities:

• 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 hold 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 or the equivalent combination of training and 5+ years of experience.

• 3+ years of Medicare and/or DSNP claims leadership preferred.

• Demonstrate Mass General Brigham Health Plan's core brand principles of always listening,

• challenging conventions and providing value.

• Bring fresh ideas forward by listening to and working with employees and the people we serve.

• Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.

• Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.

• Strong aptitude for technology-based solutions.

• Ability to inject energy, when and where it's needed.

• Current in healthcare trends.

• Demonstrated forward, visionary thinking; ability to see "what is" and envision "what could be."

• Ability to develop, introduce, defend, and gain support for new ideas and approaches.

• Excellent leadership skills and leadership track record.

• Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills are required.

• Ability to view the long-range trends and cycles of the business and industry and see the "big picture."

• Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.

• Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.

• Excellent interpersonal skills, including the ability to influence others at all levels of an organization.

• Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.

• Unquestionable integrity.

• Motivate and encourage staff; lead through change. Make decisions as needed and build consensus as appropriate. Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.

• Set clear goals and objectives and use metrics to measure performance and hold staff accountable. Provide coaching to improve performance; hold regular development discussions with direct reports. Recognize staff for their contributions.

• 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, and hold employees accountable. Provide coaching to improve performance and holds regular development meetings.

• Ensure diversity, equity, and inclusion are integrated as a guiding principle.

• This is a hybrid role with onsite meetings at the office in Assembly Row, Somerville 2x/month