Remote Claims Resolution Lead

Mass General Brigham Health Plan, Inc.; Somerville (MA); On-site; USD 80,000 - 116,000; Full time

Benefits offered by this job

Remote work eligible

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a Claims Resolution Supervisor to lead our claims review team with remote-capable options.

Based in Massachusetts, this full-time role oversees daily operations, assigns work, coaches staff, and ensures timely, compliant resolutions. The ideal candidate has 3–5 years in healthcare claims management and 1–2 years of supervisory experience, plus an Associate’s degree and strong knowledge of billing regulations.

Qualifications

• Knowledge of healthcare billing, coding, and claims regulations.
• Analyze finalized claims and identify trends.
• Lead, coach, and monitor team performance.
• Manage provider review requests and claims projects.
• Communicate clearly with providers, payers, and staff.
• Detail-oriented with strong organization and problem solving.
• Collaborate across departments to improve processes.

Responsibilities

• Supervises daily operations of the claims resolution team, including assignments and coaching.
• Manages inventory of provider review requests and claims projects, monitoring volume, aging, and completion.
• Prioritizes and distributes work based on deadlines, complexity, and resources.
• Oversees review of finalized claims submitted for reconsideration via forms, calls, and other channels.
• Identifies trends and escalates recurring issues with corrective actions.
• Coordinates with payers and internal departments to resolve claim issues.
• Develops procedures for consistent reviews and efficient inventory management.
• Ensures compliance with federal, state requirements and policies.
• Prepares reports on inventory, turnaround times, staff productivity, and outcomes.

Skills

Healthcare billing

Claims regulations

Leadership

Communication

Attention to detail

Education

Associate's degree

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking a Claims Resolution Supervisor to lead our claims review team with remote-capable options.

Based in Massachusetts, this full-time role oversees daily operations, assigns work, coaches staff, and ensures timely, compliant resolutions. The ideal candidate has 3–5 years in healthcare claims management and 1–2 years of supervisory experience, plus an Associate’s degree and strong knowledge of billing regulations.