Supervisor, Medicaid Claims Reviewer

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

Benefits offered by this job

Competitive salaries

Flexible work options

Benefits package

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a skilled leader to supervise a Claims Review team in a full‑time remote role. You will provide direction, coaching, and guidance while ensuring accurate adjudication, timely processing, and compliant practices.

The position emphasizes data‑driven improvements and collaboration across departments to optimize outcomes. The ideal candidate has 3–5 years in healthcare claims and a Bachelor’s degree, with CPC/CCS preferred.

Qualifications

• Bachelor's degree required; experience may be considered in lieu of degree.
• CPC or CCS or comparable certification preferred.
• 3–5 years in healthcare claims review or processing.

Responsibilities

• Supervise and manage a team of Claims Reviewers.
• Lead daily operations to ensure productivity and quality.
• Analyze claims data to identify trends and improvements.
• Resolve complex or high‑risk claims issues and audits.
• Collaborate with internal stakeholders to fix systemic issues.

Skills

Leadership

Claims adjudication

Data analysis

Regulatory knowledge

Education

Bachelor's degree

CPC/CCS certification preferred

Job description

Site: Mass General Brigham Health Plan Holding Company, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.

Essential Functions

• Supervise and manage a team of Claims Reviewers responsible for the accurate and timely review, adjudication, and resolution of healthcare claims.
• Provide day-to-day leadership, workload direction, coaching, and support to ensure departmental productivity, quality, and turnaround-time expectations are consistently achieved.
• Analyze claims inventory and operational data to identify trends, recurring issues, root causes, and opportunities to improve accuracy, efficiency, and overall operational performance.
• Review and resolve complex, escalated, or high-risk claims issues, including payment disputes, reimbursement concerns, authorization-related issues, and claims requiring additional research.
• Conduct or oversee claims audits and quality reviews to validate processing accuracy and identify opportunities for improvement.
• Support departmental initiatives, claims projects, reprocessing efforts, audits, regulatory requests, and other operational priorities as assigned.
• Validate claim payment calculations against applicable contracts, fee schedules, reimbursement methodologies, benefits, and other payment requirements.
• Monitor individual and team performance through established key performance indicators, quality results, productivity metrics, inventory levels, and aging trends.
• Conduct regular performance discussions, coaching sessions, and formal evaluations to support employee development, accountability, and professional growth.
• Ensure claims are reviewed and processed in accordance with applicable regulatory requirements, contractual provisions, reimbursement methodologies, payer policies, and organizational procedures.
• Identify potential underpayments, overpayments, billing discrepancies, processing errors, and systemic adjudication issues and coordinate corrective action as appropriate.
• Partner with Claims Configuration, Reimbursement Strategy, Clinical Operations, Provider Relations, Appeals and Grievances, Compliance, Finance, and other internal stakeholders to resolve claims issues and implement sustainable solutions.
• Develop, implement, and reinforce departmental policies, procedures, workflows, and controls to promote consistent and compliant claims processing.
• Escalate identified system, configuration, reimbursement, policy, or operational issues and support remediation through appropriate business and technical channels.
• Provide training, guidance, and ongoing education to new and existing staff regarding claims processing requirements, regulatory changes, reimbursement rules, departmental procedures, and system updates.
• Maintain awareness of changes to healthcare regulations, payer requirements, reimbursement methodologies, billing guidelines, and industry standards that may impact claims operations.
• Promote a culture of accountability, collaboration, continuous improvement, and exceptional service to members and providers.
• Perform other duties as assigned.

Qualifications

Education

Bachelor's degree required (experience can be considered in lieu of degree)

License

Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or comparable healthcare claims/coding certification preferred.

Experience

• At least 3-5 years of experience in healthcare claims review or processing required
• At least 1-2 years of experience in a senior or leadership role required
• Experience working within a health plan, managed care organization, third-party administrator, or similar payer environment strongly preferred.
• Experience resolving complex claims, reimbursement, coding, authorization, or payment-related issues preferred.
• Experience monitoring operational performance, including claims inventory, turnaround time, productivity, and quality metrics preferred.

Knowledge, Skills, and Abilities

Strong knowledge of healthcare claims adjudication, reimbursement, and payment methodologies. Working knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), ICD-10-CM/PCS, revenue codes, modifiers, and other healthcare coding standards. Knowledge of Medicaid and other applicable payer requirements and regulatory standards. Ability to interpret provider contracts, reimbursement provisions, fee schedules, payment policies, and claims-processing guidelines. Strong leadership and people-management skills, including coaching, performance management, employee development, and workload prioritization. Strong analytical and problem-solving skills with the ability to identify trends, perform root-cause analysis, and develop sustainable operational solutions. Ability to analyze claims data and operational metrics and translate findings into actionable recommendations. Excellent written and verbal communication skills with the ability to communicate complex claims issues clearly to both technical and non-technical stakeholders. Demonstrated ability to collaborate effectively across operational, clinical, technical, financial, and compliance functions. Strong organizational skills with the ability to manage competing priorities, escalations, deadlines, and changing business needs. High degree of accuracy, attention to detail, sound judgment, and accountability. Proficiency with healthcare claims-processing systems, workflow applications, Microsoft Office applications, and reporting or analytical tools. Ability to learn and adapt to evolving healthcare regulations, reimbursement methodologies, technologies, policies, and operational processes.

Additional Job Details (if applicable)

Working Conditions

This is a full-time role with a Monday through Friday schedule, generally 8:30-5:00 PM Eastern Time

Remote Type Remote Work Location

Remote employees must maintain a stable internet connection and a secure, private, quiet workspace appropriate for handling confidential and protected health information. Remote workspace requirements, including privacy and security standards, may be verified in accordance with organizational policy Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $79,560.00 - $115,720.80/Annual Grade 7

EEO Statement:

8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline. Combat disease. Hold a hand. Help people. Impact the world.

Mass General Brigham history and mission

Mass General Brigham is a passionate, welcoming community where minds meet caring hearts. Come be a part of the world’s most powerful force in medicine, where every role is important in changing lives. Our history includes New England hospitals founded over 200 years ago, some of the first and most prestigious hospitals in the world. Built on the legacy of two leading academic medical centers, we’re more than a system—we’re leaders in the practice of medicine. Mass General Brigham is committed to serving the community. We are dedicated to enhancing patient care, teaching and research, and taking a leadership role as an integrated health care system. We recognize that increasing value and continuously improving quality are essential to maintaining excellence.