Remote Medicaid Claims Quality Supervisor

Partner's Healthcare; Somerville (MA); 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 Medicaid claims quality, payment accuracy, and adjudication integrity. The role oversees daily inventory, analyzes denial trends, and partners with Configuration, Reimbursement Strategy, Pharmacy Operations, and Payment Integrity to strengthen outcomes.

This position ensures claims are processed efficiently and in compliance with regulatory requirements, with opportunities

Qualifications

• Bachelor's degree required; experience can be considered in lieu of degree.
• 3–5 years of experience in healthcare claims review or processing.
• 1–2 years of experience in a senior or leadership role.
• Experience working in a health plan, managed care, or payer environment preferred.
• Experience resolving complex claims, reimbursement, coding, or payment issues preferred.

Responsibilities

• Supervise and manage a team of Claims Reviewers for accurate, timely review and adjudication of healthcare claims.
• Provide day-to-day leadership, coaching, and workload direction to ensure productivity and quality.
• Analyze claims inventory and data to identify trends and opportunities for improvement.
• Review complex or high-risk claims issues and coordinate corrective actions.
• Conduct or oversee claims audits and quality reviews to validate processing accuracy.
• Collaborate with internal stakeholders to resolve claims issues and implement solutions.
• Validate payment calculations against contracts, fee schedules, and reimbursement rules.
• Monitor KPIs, throughput, and aging to manage performance.

Skills

Healthcare claims adjudication

CPT/HCPCS/ICD-10 coding

Payer requirements

Leadership

Data analysis

Education

Bachelor's degree

Tools

Microsoft Office

Claims-processing systems

Job description

Mass General Brigham Health Plan is seeking a Supervisor, Medicaid Claims Review to lead a high-performing team focused on Medicaid claims quality, payment accuracy, and adjudication integrity. The role oversees daily inventory, analyzes denial trends, and partners with Configuration, Reimbursement Strategy, Pharmacy Operations, and Payment Integrity to strengthen outcomes.

This position ensures claims are processed efficiently and in compliance with regulatory requirements, with opportunities