Senior Federal Claims & Client Operations Specialist

UMass Chan Medical School; Westborough (MA); On-site; USD 60,000 - 90,000; Full time

Job summary

UMass Chan Medical School in Westborough, MA seeks a Sr. Client Operations Specialist to compile and submit health care claims for federal, state, and private reimbursement.

You will use internal systems and portals to verify eligibility, resolve rejections, and monitor denials to ensure timely payments. As part of the Federal Claiming unit, you will review data accuracy, liaise with providers, and communicate program requirements and reimbursement opportunities.

Qualifications

• 3–5 years of related experience including medical billing support or administration.
• Strong proficiency with Microsoft Excel and core Office apps.
• Excellent written and verbal communication skills.
• Ability to work independently and meet objectives.

Responsibilities

• Review service/expenditure data for discrepancies or missing elements.
• Promptly validate data with providers as appropriate.
• Verify insurance eligibility using portals and prioritize liability.
• Review claims held or rejected for missing data or incompleteness.
• Process health care service data using internal systems.
• Analyze payments/denials to identify trends or issues.
• Troubleshoot issues to ensure timely claim processing.
• Escalate issues with detailed documentation and context.
• Serve as primary contact and SME to assigned clients.
• Review/update program documents, client info, manuals, and procedures.
• Provide ongoing outreach on program requirements and reimbursement opportunities.
• Collaborate with teammates to ensure timely client responses.
• Keep abreast of regulatory/program changes impacting reimbursement.
• Participate in testing of billing upgrades or new applications.

Skills

Strong oral & written communication

Independent work ability

Team and individual work

Education

Bachelor's Degree or equivalent

Tools

Microsoft Excel

Microsoft Word

Outlook

Teams

Job description

UMass Chan Medical School in Westborough, MA seeks a Sr. Client Operations Specialist to compile and submit health care claims for federal, state, and private reimbursement.

You will use internal systems and portals to verify eligibility, resolve rejections, and monitor denials to ensure timely payments. As part of the Federal Claiming unit, you will review data accuracy, liaise with providers, and communicate program requirements and reimbursement opportunities.