Supervisor Claims Resolution

Mass General Brigham•Somerville, MA

3d•$79,560 - $115,721•Remote

About The Position

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. Responsible for supervising the claims resolution team and managing its inventory of review requests and claims projects. The team reviews claims that have already been finalized when a provider requests further review through a form, phone call, or other channel, or when a claims project identifies items requiring review. Ensures work is assigned, prioritized, and completed accurately and on time, while providing staff guidance and maintaining compliance with applicable policies and requirements.

Requirements

Associate’s degree required. Relevant experience may be considered in lieu of a degree.
Three to five years of experience in healthcare claims management or billing required.
Strong knowledge of healthcare billing, coding, and claims regulations.
Ability to analyze finalized claims, identify trends in review requests, and resolve claim issues accurately.
Strong leadership skills, including the ability to assign work, coach staff, and monitor team performance.
Ability to manage a varied inventory of provider review requests and claims projects, set priorities, and meet deadlines.
Clear communication skills for working with providers, payers, staff, and internal departments.
Strong attention to detail, organization, and problem-solving skills.
Ability to collaborate across departments to improve claim review processes and resolution outcomes.

Nice To Haves

One to two years of supervisory or leadership experience preferred.

Responsibilities

Supervises the daily operations of the claims resolution team, including work assignments, training, coaching, and performance management.
Manages the inventory of provider review requests and claims projects, monitoring volume, aging, and completion to ensure timely resolution.
Prioritizes and distributes work based on deadlines, complexity, staff capacity, and operational needs.
Oversees the review of finalized claims submitted for reconsideration through provider forms, phone calls, and other channels.
Identifies trends in review requests, claim outcomes, and inventory; escalates recurring issues and recommends corrective actions.
Coordinates with payers and internal departments as needed to research claim issues and reach accurate resolutions.
Develops and maintains procedures that support consistent reviews, clear documentation, and efficient inventory management.
Ensures the team’s work complies with applicable federal and state requirements and organizational policies.
Prepares reports on inventory, turnaround times, staff productivity, and resolution outcomes, and identifies opportunities for improvement.