Medicaid Claims Quality Lead (Remote)

Mass General Brigham; United States; Remote; USD 80,000 - 116,000; Full time

Job summary

Mass General Brigham Health Plan is seeking a Supervisor, Medicaid Claims Review to lead a high-performing team focused on claims quality, payment accuracy, and adjudication integrity. Remote work from most US states, with standard ET hours and cross-functional collaboration across Configuration and Payment Integrity.

The role requires 3–5 years in healthcare claims review, 1–2 years in leadership, and a Bachelor's degree (CPC preferred).

Qualifications

• Bachelor’s degree required (experience can be considered in lieu of degree).
• Certified Professional Coder (CPC) preferred.
• At least 3–5 years of experience in healthcare claims review or processing.
• At least 1–2 years in a senior or leadership role.

Responsibilities

• 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.
• 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.

Skills

Leadership

Healthcare claims knowledge

Regulatory compliance

Communication

Education

Bachelor’s degree

Tools

Claims processing software

HIPAA compliance tools

Job description

Mass General Brigham Health Plan is seeking a Supervisor, Medicaid Claims Review to lead a high-performing team focused on claims quality, payment accuracy, and adjudication integrity. Remote work from most US states, with standard ET hours and cross-functional collaboration across Configuration and Payment Integrity.

The role requires 3–5 years in healthcare claims review, 1–2 years in leadership, and a Bachelor's degree (CPC preferred).