Site: Mass General Brigham Health Plan Holding Company, Inc.
Responsible for supervising the claims resolution team and managing its inventory of review requests and claims projects. The team reviews claims that have already been finalized when a provider requests further review through a form, phone call, or other channel, or when a claims project identifies items requiring review. Ensures work is assigned, prioritized, and completed accurately and on time, while providing staff guidance and maintaining compliance with applicable policies and requirements.
Essential Functions
-Supervises the daily operations of the claims resolution team, including work assignments, training, coaching, and performance management.
-Manages the inventory of provider review requests and claims projects, monitoring volume, aging, and completion to ensure timely resolution.
-Prioritizes and distributes work based on deadlines, complexity, staff capacity, and operational needs.
-Oversees the review of finalized claims submitted for reconsideration through provider forms, phone calls, and other channels.
-Identifies trends in review requests, claim outcomes, and inventory; escalates recurring issues and recommends corrective actions.
-Coordinates with payers and internal departments as needed to research claim issues and reach accurate resolutions.
-Develops and maintains procedures that support consistent reviews, clear documentation, and efficient inventory management.
-Ensures the team’s work complies with applicable federal and state requirements and organizational policies.
-Prepares reports on inventory, turnaround times, staff productivity, and resolution outcomes, and identifies opportunities for improvement.
Education
- Associate’s degree required. Relevant experience may be considered in lieu of a degree.
Experience
- Three to five years of experience in healthcare claims management or billing required.
- One to two years of supervisory or leadership experience preferred.
Knowledge, Skills, and Abilities
- Strong knowledge of healthcare billing, coding, and claims regulations.
- Ability to analyze finalized claims, identify trends in review requests, and resolve claim issues accurately.
- Strong leadership skills, including the ability to assign work, coach staff, and monitor team performance.
- Ability to manage a varied inventory of provider review requests and claims projects, set priorities, and meet deadlines.
- Clear communication skills for working with providers, payers, staff, and internal departments.
- Strong attention to detail, organization, and problem-solving skills.
- Ability to collaborate across departments to improve claim review processes and resolution outcomes.
Additional Job Details (if applicable)
Working Conditions
- This is a full-time role with a Monday through Friday schedule, generally 8:30-5:00 PM Eastern Time
- This position is eligible for remote work from approved U.S. locations, subject to organizational requirements.
- Remote employees must maintain a stable internet connection and a secure, private, quiet workspace appropriate for handling confidential and protected health information.
- Remote workspace requirements, including privacy and security standards, may be verified in accordance with organizational policy
Remote
399 Revolution Drive
40
Regular
Day (United States of America)
Pay Range
$79,560.00 - $115,720.80/Annual
Grade
7
At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
