Claims Operations Manager

Site: Mass General Brigham Health Plan Holding Company Inc.

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.

Claims Operations Manager Health Plan

The Manager Claims Operations is a critical role within the Claims Operations areas.

We are hiring for two open manager roles; Medicaid and Commercial lines of business.


Each role will oversee a large department of seasoned professionals with a wide array of skills. The ideal candidate will possess excellent communication and organizational ability. They will have a strong aptitude for technology and its impact on claims operations.

Job Summary

The Opportunity

The Claims Operations Manager is responsible for managing claims operations to ensure efficient and accurate processing of claims. Oversees claims workflows compliance and team performance to support revenue cycle goals and optimize reimbursement processes.

Responsible for planning managing and coordinating the day-to-day operations of the Claims Operations teams (including the claims reviewer team and the resolution team) ensuring that all metrics are achieved for quality time inventory and aging for original claims and provider correspondence.

Essential Functions
-Monitors accurate reporting of claim key metrics including but not limited to claim turnaround times denial rates quality scores claims over 30 and 45 days customer service statistics call tracking and correspondence inventories and turnaround data entry numbers and turnaround time.
-Set clear goals and objectives and use metrics to measure performance and hold staff accountable.
-Provide coaching to improve performance and hold regular development.
-Leads the claims operations team including hiring training and performance management.
-Oversees the processing and submission of claims to ensure accuracy timeliness and compliance with payer requirements.
-Monitors claim metrics to identify trends reduce denials and improve revenue cycle performance.
-Implements and updates policies and procedures to align with regulatory standards and organizational goals.
-Collaborates with billing coding and clinical teams to address claims issues and resolve discrepancies.
-Prepares and presents performance reports and improvement strategies to hospital leadership.

• Bachelors Degree Healthcare Administration required or bachelors degree Business Administration required or bachelors degree in a related field of study required
• Can this role consider and review experience in lieu of a degree Yes
• Certified Professional Coding - Preferred
• Experience in claims management or revenue cycle operations 5-7 years required and Experience in a supervisory or leadership role 2-3 years required

Skills For Succes

• Thorough knowledge of claims processes insurance requirements and healthcare regulations.
• Strong leadership and team management abilities.
• Proficiency in claims processing systems and revenue cycle management tools. Excellent analytical skills to assess and improve claims performance metrics.
• Effective communication and interpersonal skills for collaboration and issue resolution.
• Ability to manage multiple priorities in a fast-paced and dynamic healthcare environment.
• Experience in automation implementation and leveraging AI technology to streamline business processes.
• Attention to detail and a commitment to maintaining compliance and accuracy.

Working Model Requirements

• Hybrid role M-F Eastern Business Hours
• Quarterly meetings onsite as planned for business and team needs must be flexible
• On remote workdays employee must have a stable secure and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment.

Hybrid

399 Revolution Drive

40

Regular

Day (United States of America)

Pay Range

$97510.40 - $141804.00/Annual

Grade

8

At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

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 Veterans 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 .

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