Remote DSNP Claims Resolution Specialist

Mass General Brigham Health Plan, Inc.; United States; Remote; USD 27,000 - 39,000; Full time

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a DSNP Claims Resolution Coordinator to review, research, and resolve DSNP claim inquiries, provider correspondence, and escalations.

The role requires applying Medicare/Medicaid guidelines and ensuring timely, accurate processing in line with policies and regulatory expectations. The position emphasizes independent judgment, strong analytical skills, cross-functional collaboration, and a focus on improving member and provider

Qualifications

• 2-3 years of healthcare claims experience required.
• Knowledge of medical billing, reimbursement methodologies, and insurance claim submission processes.
• HIPAA regulations knowledge.
• Excellent written and verbal communication skills.

Responsibilities

• Review DSNP claim inquiries, provider correspondence, and escalations using internal systems.
• Determine appropriate claim action (payment, denial, adjustment) per guidelines.
• Validate benefits, authorizations, pricing, and eligibility to support accurate resolution.
• Maintain documentation in tracking systems and communicate with stakeholders to resolve issues.

Skills

Medical billing knowledge

Claims processing

HIPAA knowledge

Communication skills

Detail orientation

Education

Diploma

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking a DSNP Claims Resolution Coordinator to review, research, and resolve DSNP claim inquiries, provider correspondence, and escalations.

The role requires applying Medicare/Medicaid guidelines and ensuring timely, accurate processing in line with policies and regulatory expectations. The position emphasizes independent judgment, strong analytical skills, cross-functional collaboration, and a focus on improving member and provider