Supervisor, Medicaid Claims Reviewer

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.

This role supervises a team of roughly 5 Medicaid Claims Reviewers. Responsibilities include claims inventory management, identifying ACO claims adjudication errors, performing high-dollar reviews, noting claims denial trends, coaching and mentoring team members, and participating in the development of departmental desktop procedures.

• 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
• Perform other duties as assigned
• Ensure that 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, over payments, 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

• 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

• This is a full-time role with a Monday through Friday, 8:30-5 schedule
• This is a remote role that can be done from most U.S. states

$78,000.00 - $ per year

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 .

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.