Remote Claims Resolution Leader

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

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a claims supervisor to lead the daily operations of the claims resolution team. You will assign work, coach staff, and monitor performance to ensure timely resolutions.

The role requires 3–5 years in healthcare claims management or billing with 1–2 years of supervisory experience; strong knowledge of billing regulations and internal processes is essential.

Qualifications

• Strong knowledge of healthcare billing, coding, and claims regulations.
• Ability to analyze finalized claims, identify trends in review requests, and resolve issues accurately.
• Strong leadership skills to assign work, coach staff, and monitor performance.

Responsibilities

• Supervises the daily operations of the claims resolution team, including work assignments, coaching, and performance management.
• Manages the inventory of provider review requests and claims projects, monitoring volume and aging.
• Prioritizes and distributes work based on deadlines, complexity, staff capacity, and needs.
• Oversees the review of finalized claims submitted for reconsideration through provider forms, calls, and other channels.
• Identifies trends in review requests and outcomes; escalates issues and recommends corrective actions.
• Coordinates with payers and internal departments to research claim issues and reach resolutions.
• Develops and maintains procedures supporting consistent reviews, documentation, and inventory management.
• Ensures the team’s work complies with applicable federal and state requirements and policies.
• Prepares reports on inventory, turnaround times, staff productivity, and resolution outcomes.

Skills

Healthcare claims management

Billing

Supervisory/leadership

Data analysis

Education

Associate’s degree

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking a claims supervisor to lead the daily operations of the claims resolution team. You will assign work, coach staff, and monitor performance to ensure timely resolutions.

The role requires 3–5 years in healthcare claims management or billing with 1–2 years of supervisory experience; strong knowledge of billing regulations and internal processes is essential.