Medicaid Claims Lead — Remote Team Supervision

8925 Mass General Brigham Health Plan Holding Company, Inc.; Somerville (MA); Remote; USD 80,000 - 116,000; Full time

Benefits offered by this job

Competitive salaries

Flexible work options

Benefits package

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a skilled leader to supervise a Claims Review team in a full‑time remote role. You will provide direction, coaching, and guidance while ensuring accurate adjudication, timely processing, and compliant practices.

The position emphasizes data‑driven improvements and collaboration across departments to optimize outcomes. The ideal candidate has 3–5 years in healthcare claims and a Bachelor’s degree, with CPC/CCS preferred.

Qualifications

• Bachelor's degree required; experience may be considered in lieu of degree.
• CPC or CCS or comparable certification preferred.
• 3–5 years in healthcare claims review or processing.

Responsibilities

• Supervise and manage a team of Claims Reviewers.
• Lead daily operations to ensure productivity and quality.
• Analyze claims data to identify trends and improvements.
• Resolve complex or high‑risk claims issues and audits.
• Collaborate with internal stakeholders to fix systemic issues.

Skills

Leadership

Claims adjudication

Data analysis

Regulatory knowledge

Education

Bachelor's degree

CPC/CCS certification preferred

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking a skilled leader to supervise a Claims Review team in a full‑time remote role. You will provide direction, coaching, and guidance while ensuring accurate adjudication, timely processing, and compliant practices.

The position emphasizes data‑driven improvements and collaboration across departments to optimize outcomes. The ideal candidate has 3–5 years in healthcare claims and a Bachelor’s degree, with CPC/CCS preferred.