Supervisor, Medicaid Claims Reviewer

Mass General Brigham•Somerville, MA

2d•$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. The Supervisor, Medicaid Claims Review is responsible for leading a high-performing team focused on Medicaid claims quality, payment accuracy, and adjudication integrity. This role oversees daily inventory management while driving continuous improvement through denial trend analysis, high-dollar claim oversight, and proactive identification of adjudication risks. The Supervisor partners cross-functionally with Configuration, Reimbursement Strategy, Pharmacy Operations, and Payment Integrity to strengthen claims outcomes and reduce rework across the enterprise. Responsible for overseeing a team that assesses Medicaid claims for accuracy, compliance, and eligibility, ensuring that claims are processed efficiently and in accordance with industry standards, regulatory requirements, and organizational policies. This position will guide and support the claims review team, handle escalations, and collaborate with other departments to improve claims processing and ensure timely reimbursements.

Requirements

Bachelor's degree required (experience can be considered in lieu of degree)
Certified Professional Coder (CPC) preferred
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
Strong knowledge of healthcare claims processes, coding (CPT, ICD-10), and payer regulations
Excellent leadership, communication, and problem-solving skills
Proficiency in claims processing software and healthcare management systems
Strong attention to detail and the ability to manage multiple tasks and priorities

Responsibilities

Supervise and manage a team of claims reviewers to ensure accurate and timely healthcare claims processing
Oversee claims review and analysis to ensure compliance with healthcare regulations, payer requirements, and organizational policies
Resolve escalated or complex claims issues, ensuring appropriate adjudication and dispute resolution
Monitor team performance, provide feedback, and conduct regular evaluations to support professional growth
Implement and enforce policies and procedures to streamline the claims review process for greater accuracy and efficiency
Collaborate with billing, coding, and compliance teams to ensure adherence to regulatory and payer standards
Analyze claims data to identify trends, address issues, and recommend process improvements
Provide training, guidance, and ongoing education for new and existing team members on industry changes and standards
Performs other duties as assigned
Ensure that the medical claims include complete and accurate documentation supporting the services rendered, including physician notes, test results, and other relevant records.
Analyze claim payment amounts and compare them to contracted rates, fee schedules, and industry benchmarks.
Identify underpayments, overpayments, and potential billing errors.
Conduct comprehensive audits of medical claims to verify compliance with billing regulations, payer policies, and internal policies and procedures.
Stay updated on insurance company policies, billing guidelines, and reimbursement rules.