Remote Medicaid Claims Supervisor

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

Job summary

Mass General Brigham Health Plan Holding Company, Inc. seeks a Supervisor, Medicaid Claims Review to lead a high‑performing team focused on claims quality, payment accuracy, and adjudication integrity. This role oversees daily inventory and collaborates with cross‑functional partners to strengthen outcomes.

The position requires a Bachelor's degree, CPC/CCS preferred, 3–5 years in claims review, and strong leadership. Remote work eligibility, with standard hours 8:30–5 ET, Monday–Friday.

Qualifications

• Bachelor's degree required; experience may substitute for degree.
• Strong knowledge of Medicaid claims adjudication and reimbursement.
• Experience leading a claims review team and driving quality improvements.

Responsibilities

• Supervise a team of claims reviewers ensuring accurate adjudication.
• Monitor performance metrics, inventory levels, and aging trends.
• Analyze complex claims, escalations, and high‑risk issues for resolution.
• Collaborate with Config, Reimbursement Strategy, and Compliance to improve outcomes.

Skills

Leadership

Claims review

Team management

Analytical skills

Communication

Regulatory compliance

Problem solving

Cross-functional collaboration

Education

Bachelor's degree

CPC/CCS certification preferred

Tools

Claims processing systems

Microsoft Office

Job description

Mass General Brigham Health Plan Holding Company, Inc. seeks a Supervisor, Medicaid Claims Review to lead a high‑performing team focused on claims quality, payment accuracy, and adjudication integrity. This role oversees daily inventory and collaborates with cross‑functional partners to strengthen outcomes.

The position requires a Bachelor's degree, CPC/CCS preferred, 3–5 years in claims review, and strong leadership. Remote work eligibility, with standard hours 8:30–5 ET, Monday–Friday.