Remote Member Advocacy and Case Resolution Specialist

Mass General Brigham Health Plan, Inc.; United States; Remote; USD 30,000 - 43,000; Full time

Job summary

Mass General Brigham Health Plan Holding Company, Inc. seeks a Member Advocacy Coordinator to manage ODAG cases from intake to resolution in a remote setting. You will investigate, document, and coordinate with health plan departments to ensure accurate issue resolution.

The role focuses on improving the member experience, quality, and compliance, with strong emphasis on timely, compliant handling of oral dissatisfaction, appeals and grievances.

Qualifications

• High School Diploma or Equivalent required.
• Experience in health plan customer service, quality, or appeals and grievances preferred.
• Administrative and billing/claims exposure is a plus.

Responsibilities

• Handle a high volume of ODAG cases from intake through resolution with proper research.
• Ensure documentation and compliance with regulatory timelines for member communications.
• Review and route ODAG cases, maintaining thorough notes and supporting evidence.
• Escalate member/provider feedback to key stakeholders and identify process improvements.
• Prepare case files for CMS/HPMS and other high-priority escalations.

Skills

Customer service

Communication

Time management

Adaptability

Attention to detail

Education

High school diploma

Job description

Mass General Brigham Health Plan Holding Company, Inc. seeks a Member Advocacy Coordinator to manage ODAG cases from intake to resolution in a remote setting. You will investigate, document, and coordinate with health plan departments to ensure accurate issue resolution.

The role focuses on improving the member experience, quality, and compliance, with strong emphasis on timely, compliant handling of oral dissatisfaction, appeals and grievances.