Claims Supervisor jobs in Massachusetts

Supervisor, Medicaid Claims Reviewer

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on 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 consciously inclusive environment where diversity is celebrated.

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

Supervise the Claims Review Team in compliance with Mass General Brigham Health Plan's policies and procedures including:

• Train, motivate, develop and evaluate staff in compliance with established policies, practices and procedures.
• Set and approve work schedules, time off requests, overtime and approve timecards.
• Schedule staff for needed training and development.
• Mentor and coach, the claims staff regarding Mass General Brigham Health Plan and Center for Medicare & Medicaid Services (CMS) policies, procedures, processing techniques and performance.
• Plan and facilitate regular monthly team and one on one meetings keeping employees up to date and well informed of company and departmental activities/ happenings.
• Manage employee performance in compliance with company policy up to and including termination.
• Supervise and provide guidance to the work of the Claims Team ensuring service, quality and productivity standards are met.
• Run and analyze reports to manage the inventory of claims.
• Distribute work taking into account department metrics.
• Review aging and inventory of pended claims to maintain at acceptable levels; prioritize the type of work based on the inventory and where necessary escalate if approaches/exceeds target on-hand inventory level.
• Research and find solutions for issues escalated or delegated from team members, internal customers, or Manager.
• Ensure daily productivity reports are produced, maintained and distributed to direct reports.
• Recommend changes in claims operating policies and procedures and give input to desktop procedures.
• Identify and request clarification and/or updates to policies and procedures, as needed.
• Recommend and participate in development and implementation of departmental work standards, policies and procedures.
• Assist in testing new processes, system updates and upgrades.
• Assist with centralized training.
• Identify and provide claim scenarios.
• Co-facilitate training sessions as needed.
• Identify systemic issues and trends and work with issue owners to find resolution.
• Hold self and others accountable to meet commitments.
• Build strong customer relationships and deliver solutions that meet customer expectations; establish and maintain effective customer relationships – both internal as well as external.
• Monitor and maintain existing processes to ensure expected outcome.
• Assist in the development and implementation of new processes as needed.
• Inform, engage, inspire, motivate, and actively listen to employees.
• Make decisions that put the needs of the people we serve—our members, providers, brokers, and employers—front and center.
• Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
• Identify/create processes and align resources to accomplish key objectives; clearly convey and assign clear accountability for important objectives, deadlines, and expectations.
• Hire, participate in, and/or recommend development measures and disciplinary actions up to and including termination; evaluate performance and supervise the work of all direct and indirect reports following established organizational policies, procedures, and practices.
• Set clear goals and objectives, use metrics to measure performance, and hold employees accountable. Provide coaching to improve performance and holds regular development meetings.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Hold self and others accountable to meet commitments.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles or setbacks.
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.

• Bachelor’s Degree or the equivalent combination of training and experience
• Plus 5 years of related experience

• Strong supervisory skills
• Knowledge of Medicaid/ACO claims processing.
• Demonstrate Mass General Brigham Health Plans' core brand principles of always listening, challenging conventions, and providing value.
• Bring fresh ideas forward by listening to and working with employees and the people we serve.
• Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
• Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it’s needed.
• Current in healthcare trends.
• Demonstrated forward, visionary thinking; ability to see “what is” and envision “what could be.”
• Ability to develop, introduce, defend, and gain support for a new ideas and approaches.
• Excellent leadership skills and leadership track record.
• Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation and communication skills. Strong verbal, active listening, and written communication skills required.
• Ability to view the long-range trends and cycles of the business and industry and see the “big picture.”
• Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
• Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
• Excellent interpersonal skills, including the ability to influence others at all levels of an organization.