Member Advocacy Coordinator

Mass General Brigham Health Plan Holding Company, Inc.; Somerville (MA); On-site; USD 30,000 - 44,000; Full time

Benefits offered by this job

Comprehensive benefits

Career advancement opportunities

Bonuses as applicable

Recognition programs

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a Member Advocacy Coordinator to support the Customer Service team by handling oral dissatisfaction, ODAG cases, and service recovery from intake to resolution.

The role emphasizes thorough research, accurate documentation, and timely escalation to ensure compliant, quality member outcomes. The position requires strong communication, organization, and technology skills, with experience in health plan operations and regulatory

Qualifications

• Strong aptitude for technology-based solutions and data/documentation accuracy.
• Excellent communication and interpersonal skills for member interactions.
• Ability to adapt to changing priorities in a dynamic healthcare environment.
• Excellent organizational abilities to manage multiple tasks and deadlines.

Responsibilities

• Handle high volume ODAG (Oral Dissatisfaction, Appeals, Grievance) cases from intake to resolution.
• Ensure accurate documentation and timely follow-up for compliance and turnaround times.
• Review, triage, and route cases across tracking systems with high accuracy.
• Coordinate with Appeals, Operations, and other departments to resolve issues and provide feedback.
• Prepare case files for CMS/HPMS escalations and maintain supporting documentation.

Skills

Technology-based solutions

Customer service

Communication skills

Adaptability

Organization

Education

High School Diploma or equivalent

Associate's Degree in related field (preferred)

Job description

Site: Mass General Brigham Health Plan Holding Company, Inc.Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.Job SummaryThe Member Advocacy Coordinator serves as a dedicated quality, research, and investigative resource within the Customer Service department. This role oversees oral dissatisfaction, coverage determination, and organization determination (ODAG), and service recovery cases from intake to ensure proper intake is adequate for first-call resolution or that additional information is required to update and route to the appropriate department for resolution. The coordinator conducts case research, reviews member interactions and documentation, identifies trends and opportunities for process improvement, and partners with leadership to improve the member experience, quality, and compliance. The role primarily focuses on investigation and on coordinating cross-functional communication between Health Plan departments to ensure accurate issue resolution.Essential Functions-Handle a high volume of Oral Dissatisfaction, Appeals, and Grievance (ODAG) cases from verbal intake through resolution, conducting research and investigation as needed to ensure concerns are appropriately addressed or routed to the correct department for resolution.-Ensure accurate documentation, timely follow-up, and compliance with contractual and regulatory turnaround time requirements for member communications.-Review, triage, and route ODAG cases within designated tracking systems, ensuring all work is completed with a high degree of accuracy, quality, and attention to detail. Maintain comprehensive case documentation, including detailed ODAG notes, research findings, member outreach efforts, resolution activities, and all supporting information necessary to support effective case management, regulatory compliance, and timely resolution.-Assist in communicating and escalating member and provider feedback to appropriate stakeholders, including Appeals & Grievances, Provider Appeals, Operations, and other business areas. Analyze recurring themes and trends, and provide recommendations to enhance reporting, strengthen operational insights, and improve processes, service delivery, and member experience outcomes.-Prepare and maintain case files for CMS, HPMS, and other high-priority escalations, ensuring all supporting documentation, research, and responses are complete, accurate, and submitted within established regulatory and contractual deadlines.-Provide members with helpful, appropriate information on an ongoing basis as you resolve their issues.-Coordinates with appropriate departments to resolve payment and claims processing issues and to identify system improvements that will, in turn, reduce member appeals.