DSNP Claims Review Specialist - Remote

8925 Mass General Brigham Health Plan Holding Company, Inc.; Somerville (MA); Remote; USD 25,000 - 34,000; Full time

Benefits offered by this job

Remote work

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a D-SNP Claims Review Specialist to process SCO and One Care claims, ensuring accurate adjudication and compliance. The role supports remote work from most US states with a 40-hour week and competitive pay.

You will review claims, verify pricing and authorizations, and enter data as needed while collaborating with other departments to resolve issues. Healthcare knowledge and strong customer service are essential.

Qualifications

• Hands-on experience with SCO and OneCare claims processing.
• Proficiency in QNXT or similar claims adjudication systems (e.g., Facets).
• Knowledge of healthcare claims processes and standard billing codes.
• Strong customer service orientation and effective communication.

Responsibilities

• Adjudicate D-SNP/SCO and OneCare claims in alignment with policy and procedures.
• Review and research claims across systems, verify pricing, contracts, and authorizations.
• Enter claims into processing systems when needed.
• Apply benefits correctly per policies and care plans.
• Collaborate with external teams to resolve claim issues promptly.
• Utilize training resources to stay current with processes.
• Meet performance goals for productivity, accuracy, and attendance.
• Document updates in call tracking and reporting systems.
• Identify and escalate system or pricing issues as they arise.

Skills

SCO claims processing

OneCare claims processing

Medical billing terminology

Customer service

Education

High School Diploma or Equivalent

Associate's degree preferred

Tools

QNXT

Facets

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking a D-SNP Claims Review Specialist to process SCO and One Care claims, ensuring accurate adjudication and compliance. The role supports remote work from most US states with a 40-hour week and competitive pay.

You will review claims, verify pricing and authorizations, and enter data as needed while collaborating with other departments to resolve issues. Healthcare knowledge and strong customer service are essential.