Branch Review Specialist jobs in Malden, MA

Branch Review Specialist conducts branch internal audits to determine whether business controls are sufficient and effectively executed in accordance with bank policies and procedures. Tests established procedures to ensure operational efficiency within branch offices. Being a Branch Review Specialist determines whether branches are performing their planning, accounting, custodial, or business control activities in compliance with management instructions, policies, and procedures. Evaluates functions and activities in assigned areas to determine the nature of operations and the adequacy of systems to achieve established objectives. Additionally, Branch Review Specialist recommends corrective actions and improvements. Requires a bachelor's degree. Typically reports to a supervisor or manager. The Branch Review Specialist occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Branch Review Specialist typically requires 2 -4 years of related experience. (Copyright 2024 Salary.com)

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Claims Review Specialist
  • Mass General Brigham Health Plan
  • Somerville, MA FULL_TIME
  • Claims Review Specialist

    - (3280309)

    This is a hybrid role requiring an onsite presence to the Somerville office 1x/month.
    The Claim Reviewer is responsible for the adjudication of claims adhering to Mass General Brigham Health Plans current administrative policies and procedures, clinical guidelines, unbundling software and other system edits. The reviewer will adjudicate the claims by reviewing hospital and/or physician contracts, fee schedules, and current billing guidelines. This requires an in-depth review of authorizations including non-clinical notes and Letters of agreement. In addition, this position also requires problem resolution skills and judgment skills to determine the appropriate staff to assist with the resolution, depending on the issue (i.e. contracting, configuration, IT, Supervisor).
    • Meets quality and production claims processing standards
    • Independently processes all types of routine claims with minimal assistance, pays, denies, or pends as appropriate in a timely and accurate manner
    • Process and price complex Home Infusion claims
    • Maintains current knowledge of assigned plan(s) and effectively applies this knowledge in the processing of claims and in providing customer service to internal stakeholders
    • Manually enters claims into QNXT as needed
    • Ability to review and interpret information from various sources and databases such as Code Check, KCII, Novologix, Optum Fusion and other vendors and software
    • Assists other staff with questions pertaining to the processing of claims; directs questions and problems to the appropriate person for resolution
    • Process troubleshooter reports as assigned
    • Identify and escalate system issues, configuration issues, pricing issues etc. in a timely manner
    • Interprets contracts and edit steps correctly and applies to processing

    Basic Requirements:
    • High School Diploma or equivalent experience
    • Pharmacy Technician certification is required
    • 2-3 years of previous experience in the health insurance industry in functions such as previous claims processing, hospital or physician biller, call center experience working with providers, or similar industry experience
    • Attention to detail, decision making problem solving, time management and organizational skills, communication and teamwork.
    • Basic math and language skills
    • Demonstrated competency in data entry

    Preferred Qualifications:
    • Knowledge of ICD-10, HCPCS, CPT-4, and Revenue Codes.
    • Knowledge of medical terminology
    • Knowledge of claim forms (professional and facility)
    • Knowledge of Home Infusion Claim Processing
    • Knowledge of paper vs. electronic filing and medical billing guidelines preferred
    • Completion of coding classes from certified medical billing school preferred
    EEO Statement


    Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. 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 the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.


    Primary Location MA-Somerville-MGB Health Plan at Assembly Row
    Work Locations MGB Health Plan at Assembly Row 399 Revolution Drive Somerville 02145
    Job Admin/Clerical/Cust Service
    Organization Mass General Brigham Health Plan
    Schedule Full-time
    Standard Hours 40
    Shift Day Job
    Employee Status Regular
    Recruiting Department MGB Health Plan Claims
    Job Posting Mar 5, 2024

  • 19 Days Ago

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Hardware Specialist– Circuit Design Review
  • Expleo
  • Bucharest, MA FULL_TIME
  • Overview #LI-LA1 In the relationship with Suppliers and Development Leaders, the role of a Review Specialist is to reinforce the application of development rules and regulations, by means of identific...
  • 20 Days Ago

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Hardware Specialist– Circuit Design Review
  • Expleo Group
  • Bucharest, MA FULL_TIME
  • Overview #LI-LA1 Expleo is a global engineering, technology, and consulting service provider that partners with leading organizations to guide them through their business transformation, helping them ...
  • 1 Month Ago

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Review Specialist - Office of Research Subject Protection
  • Broad Institute
  • Cambridge, MA FULL_TIME
  • Job DescriptionThe is seeking an experienced Review Specialist. The Review Specialist supports the Broad's Office of Research Subject Protection (ORSP). It works to ensure adherence to regulatory and ...
  • 1 Month Ago

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Branch Operations Specialist (Woburn, MA)
  • Northern Bank
  • Woburn, MA FULL_TIME
  • The primary role of the Branch Operations Specialist is to ensure the operational integrity and compliance for the branch, including both sales and service functions. The Branch Operations Specialist ...
  • 24 Days Ago

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Office Specialist - Medical Office
  • TruGreen - Lawn Specialist
  • Roxbury, MA FULL_TIME
  • TruGreen is Now Hiring Lawn Specialists!00 per Hour - Comprehensive Benefits 00 per hour Average income is $850 - $1,200 per week* - Based on hourly rate and average bonuses earned for qualifying spec...
  • 21 Days Ago

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0 Branch Review Specialist jobs found in Malden, MA area

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Member Experience Specialist II
  • Massachusetts Institute of Technology
  • Cambridge, MA
  • REQUIRED: high school diploma or its equivalent; three years' related experience, preferably in financial services; abil...
  • 3/28/2024 12:00:00 AM

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Inside Sales Representative
  • Rexel Group
  • Boston, MA
  • Rexel is a global leader specializing in the multi-channel distribution of electrical products and services for the ener...
  • 3/28/2024 12:00:00 AM

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Account Manager
  • TDF Fleet
  • Boston, MA
  • The Driving Force Inc.’s (TDFI) US division TDF Fleet is currently hiring an Account Manager. The Account Manager is res...
  • 3/27/2024 12:00:00 AM

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DIGITAL IMAGING SPECIALIST, University Libraries
  • Boston University
  • Boston, MA
  • Job Description Boston University Libraries seeks a Digital Imaging Specialist, who will play a key role in increasing t...
  • 3/26/2024 12:00:00 AM

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HVAC Controls Install Manager
  • Johnson Controls International
  • Lynnfield, MA
  • Build your best future with the Johnson Controls team. As a global leader in smart, healthy and sustainable buildings, o...
  • 3/25/2024 12:00:00 AM

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Store Customer Service Specialist
  • Sherwin-Williams
  • Wilmington, MA
  • This is position is essential to the success of our retail stores. Customer Service Specialists work closely with wholes...
  • 3/25/2024 12:00:00 AM

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CATALOGING AND METADATA LIBRARIAN, University Libraries
  • Boston University
  • Boston, MA
  • The Boston University Libraries seek an experienced, forward-thinking, and creative professional to provide leadership, ...
  • 3/25/2024 12:00:00 AM

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Local CDL B Driver
  • Heritage Wholesalers - Malden
  • Malden, MA
  • Local CDL B Driver We are committed to the personal and professional growth of our team members and we show this by havi...
  • 3/7/2024 12:00:00 AM

Malden is a city in Middlesex County, Massachusetts, United States. At the time of the 2010 United States Census, the population was at 59,450 people. In 2009, Malden was named the "Best Place to Raise Your Kids" in Massachusetts by Bloomberg Businessweek. Malden is bordered by Melrose on the north, Stoneham on the northwest, Medford on the west, Everett on the south, Revere on the east, and Saugus on the northeast. Boojum Rock located in the north west corner of Malden inside the Middlesex Fells Reservation is the highest point in Malden with an elevation of approximately 275 feet. According...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Branch Review Specialist jobs
$56,285 to $73,189
Malden, Massachusetts area prices
were up 2.5% from a year ago

Branch Review Specialist in Columbus, MS
The branch review specialist job description covers overall performance of a branch.
December 15, 2019
Branch Review Specialist in Muskegon, MI
When a branch is not working at its best, a review specialist comes in.
January 05, 2020
Branch Review Specialist in New Brunswick, NJ
A branch review specialist has a specific set of duties outside of management and basic customer service within a bank branch.
January 16, 2020