Federal Claims & Reimbursements Specialist

UMass Med School; Westborough (MA); On-site; USD 48,000 - 58,000; Full time

Job summary

UMass Med School in Westborough, MA is seeking a Sr. Client Operations Specialist to compile and submit claims for federal and private reimbursements, verify eligibility, and resolve denials. You will serve as the expert contact for contracted clients and ensure timely processing using internal systems.

The role requires 3–5 years of related experience, strong Excel skills, and excellent communication. This is a full-time position within the Federal Claiming unit, supporting school-based health

Qualifications

• Bachelor's Level Degree or equivalent work experience.
• 3-5 years of related experience including but not limited to medical billing support, customer service, program coordination or administration.
• Strong proficiency with Microsoft Excel.
• Proficiency with other essential Microsoft Office applications (Word, Outlook, Teams).
• Strong oral and written communication skills.
• Demonstrated ability to work independently to achieve objectives.
• Work effectively in both team and individual environments.
• Federal claiming or medical billing experience (preferred).
• Familiarity with Random Moment Time Study or other cost allocation tools (preferred).

Responsibilities

• Review service or expenditure data for discrepancies and/or missing data.
• Promptly validate data with providers, as appropriate.
• Verify insurance eligibility using portals and prioritize primary/secondary liability.
• Review service claims held or rejected for missing data or incomplete elements.
• Process health care service and expenditure data using internal systems.
• Analyze payments/denials to identify trends or issues.
• Troubleshoot issues to ensure timely processing of claims.
• Escalate issues with detailed documentation to support explanations.
• Serve as primary contact and subject matter expert to assigned clients.
• Review, maintain, update and disseminate program documents and procedures.
• Provide outreach and communication on requirements and reimbursement opportunities.
• Collaborate with team members to ensure timely responses to customers.
• Stay abreast of regulatory or program changes impacting reimbursement requirements.
• Participate in testing billing system upgrades or new applications.

Skills

Excel

Word

Outlook

Teams

Oral & Written Communication

Independent Work

Teamwork

Education

Bachelor's Degree or equivalent

Tools

Microsoft Office

Job description

UMass Med School in Westborough, MA is seeking a Sr. Client Operations Specialist to compile and submit claims for federal and private reimbursements, verify eligibility, and resolve denials. You will serve as the expert contact for contracted clients and ensure timely processing using internal systems.

The role requires 3–5 years of related experience, strong Excel skills, and excellent communication. This is a full-time position within the Federal Claiming unit, supporting school-based health