Site: Mass General Brigham Health Plan Holding Company, Inc.

 

At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission—from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community.  We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.

At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare — people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds – to apply.

 

This is a hybrid role that requires an onsite presences at the office 1x/month.

 

Job Summary

Responsible for overseeing a team that assesses healthcare claims for accuracy, compliance, and eligibility, ensuring that claims are processed efficiently and in accordance with industry standards, regulatory requirements, and organizational policies. This position will guide and support the claims review team, handle escalations, and collaborate with other departments to improve claims processing and ensure timely reimbursements.

 

Qualifications

Essential Functions

Supervise and manage a team of claims reviewers to ensure accurate and timely healthcare claims processing.Oversee claims review and analysis to ensure compliance with healthcare regulations, payer requirements, and organizational policies. Resolve escalated or complex claims issues, ensuring appropriate adjudication and dispute resolution. Monitor team performance, provide feedback, and conduct regular evaluations to support professional growth. Implement and enforce policies and procedures to streamline the claims review process for greater accuracy and efficiency. Collaborate with billing, coding, and compliance teams to ensure adherence to regulatory and payer standards. Analyze claims data to identify trends, address issues, and recommend process improvements. Provide training, guidance, and ongoing education for new and existing team members on industry changes and standards. 

 

Additional Job Details (if applicable)

Education

Bachelor's Degree Healthcare Administration required or Bachelor's Degree Related Field of Study required

Can this role accept experience in lieu of a degree?
Yes


Experience

Experience in healthcare claims review or processing 3-5 years requiredExperience in a senior or leadership role 1-2 years required

Knowledge, Skills and Abilities

Strong knowledge of healthcare claims processes, coding (CPT, ICD-10), and payer regulations.Excellent leadership, communication, and problem-solving skills.Proficiency in claims processing software and healthcare management systems.Strong attention to detail and the ability to manage multiple tasks and priorities.

Physical Requirements

Standing Occasionally (3-33%)Walking Occasionally (3-33%)Sitting Constantly (67-100%)Lifting Occasionally (3-33%)Carrying Occasionally (3-33%)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%)

 

Remote Type

Hybrid

 

Work Location

399 Revolution Drive

 

Scheduled Weekly Hours

40

 

Employee Type

Regular

 

Work Shift

Day (United States of America)

 

EEO Statement:

Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

 

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.