Claims Production Specialist

Baystate Health • Springfield, MA

3d • Remote

About The Position

Baystate Health’s Health New England is seeking a detail-oriented Claims Production Specialist to join its Claims team. The specialist supports accurate and timely processing, adjustment, recovery, and finalization of medical claims in accordance with established policies, quality standards, and regulatory requirements. The role contributes to efficient operations and positive provider experiences. This is a fully remote opportunity for candidates who live in Massachusetts or Connecticut.

Requirements

• At least 3 years of experience in healthcare claims administration, medical claims processing, provider billing, or provider payment posting and reconciliation.
• High school diploma or equivalent.
• Knowledge of medical coding and billing methodologies, including CPT-4, ICD-10, UB-04, and HCFA-1500.
• Familiarity with healthcare regulations and payer requirements, including HIPAA, ACA, CMS, MassHealth, and ERISA.
• Experience with claims processing systems, medical claims editing platforms, or medical pricing tools.
• Strong analytical, critical-thinking, and problem-solving skills.
• Excellent communication and collaboration skills.
• Proficiency in Microsoft Word, Excel, and Outlook.
• Commitment to accuracy, confidentiality, compliance, and continuous learning.
• Must live in Massachusetts or Connecticut.

Responsibilities

• Review and finalize medical claims, adjustments, and retractions in accordance with established policies and procedures.
• Investigate pending claims, research discrepancies, and coordinate with claims adjudication partners and vendors to resolve issues.
• Meet productivity and accuracy goals and help deliver consistent, high-quality results.
• Recognize unusual claims trends, processing variations, and potential issues, escalating findings to senior team members.
• Partner with Senior Claims Production Specialists, Finance, ASO, and external vendors to resolve claims issues and process provider refunds.
• Manage incoming claims inquiries and requests accurately and within established timelines.
• Maintain confidentiality, follow regulatory requirements, and uphold ethical business practices.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED