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Claims Team Lead
Mass General Brigham Health Plan
-
Somerville, MA
Manage and distribute work as designated Run and analyze reports Review aging and inventory levels Hold self and others accountable to meet commitments Assist in testing new processes, system updates and upgrades Identify and provide claim scenarios for testing when needed Assist in the development, implementation, and delivery of training Functions as coach, mentor and r
Email Job
Posted Today
Special Investigations Fraud Analyst
Mass General Brigham Health Plan
-
Somerville, MA
Use knowledge of healthcare coding conventions to develop and run reports, analyze data to identify suspicious billing patterns, assess the merits of allegations, and present those findings to leadership. Analyze claims data to find suspicious billing patterns and outliers, using knowledge of healthcare coding conventions, fraud schemes, and general areas of vulnerabiliti
Email Job
Posted Today
Actuarial Analyst II
Mass General Brigham Health Plan
-
Somerville, MA
Leads reserving analysis and communication of financial results to senior leadership. Responsible for developing monthly IBNR, reviewing claims projects, updating lag files, and supporting of other actuarial accruals (MLR Rebate, MassHealth Corridors and Settlements, Risk Adjustment, Cost Sharing Reduction Accrual, etc.) Supports the quarterly forecasting of Mass General
Email Job
Posted 4 days ago
Supervisor, Government Programs Utilization Management
Mass General Brigham Health Plan
-
Somerville, MA
This is a remote role with occasional (roughly 1x/every other month) onsite team meetings in Somerville, MA. 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
Email Job
Posted 4 days ago
Clinical Support Coordinator
Mass General Brigham Health Plan
-
Somerville, MA
This is a remote role with occasional (roughly 1x/every other month) onsite team meetings in Somerville, MA. 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
Email Job
Posted 4 days ago
Medicare Advantage Project Coordinator (Remote)
Mass General Brigham Health Plan
-
Somerville, MA
Works with the Director, Medicare Advantage Program and Innovation Operations, and health plan business areas/departments to execute the annual Medicare Advantage work plan which includes standard work and large, complex, cross functional projects Identifies and escalates for visibility any issues, risks or decisions needed to prevent or remove barriers to completing task
Email Job
Posted 4 days ago
Customer Service Professional
Mass General Brigham Health Plan
-
Somerville, MA
Serve as the primary liaison for members and providers for all lines of business including MassHealth, and Commercial members regarding general program inquires such as eligibility verifications, authorizations, referrals, claims, material fulfillment, address changes and Primary Care Physician assignments as well as member related policy and procedures. The CSP must be a
Email Job
Posted 5 days ago
Senior Actuarial Analyst
Mass General Brigham Health Plan
-
Somerville, MA
Supports reserving analysis and communication of financial results to senior leadership. Responsible for monthly IBNR and other actuarial accruals (MLR Rebate, risk adjustment, PDR, Provider Bonus, High Cost Risk Pool, etc.). Quarterly forecasting of Mass General Brigham Health Plan financial statements for purposes of business planning. Responsible for monthly MLR model
Email Job
Posted 5 days ago
Claims Resolutions Coordinator
Mass General Brigham Health Plan
-
Somerville, MA
Review and research assigned claims by navigating multiple systems and platforms and accurately capturing the data/information necessary for processing (e.g., verify pricing/Fee Schedules, contracts and Letters of Agreement, prior authorizations, applicable member benefits) Pay, deny, or pend claims as appropriate in a timely manner. Manually enters claims into QNXT as ne
Email Job
Posted 10 days ago
Sr. Information Mgt Developer
Mass General Brigham Health Plan
-
Somerville, MA
Information Management Developer Leads analysis, design, development, and testing of operational and regulatory reporting for Medicare and Medicaid lines of business. Produces data sets for end users and or regulatory entities. Produces data reconciliation between various data sources to ensure regulatory compliance. Extracts and collects data for performing queries and w
Email Job
Posted 10 days ago
Sr. Data Analyst
Mass General Brigham Health Plan
-
Somerville, MA
Evaluate and analyze data using T SQL, Excel, and PowerBI and other BI tools to design, develop, and test analytic solutions from various data sources. Analyze, Interpret, and validate results of analytic, BI, and reporting solutions produced by the reporting, BI, and Data Architecture teams. Create and revise process flows, data flows, data requirement specifications, us
Email Job
Posted 10 days ago
Utilization Management Care Manager
Mass General Brigham Health Plan
-
Somerville, MA
This is a remote role with occasional (roughly 1x/every other month) onsite team meetings in Somerville, MA. 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
Email Job
Posted 12 days ago
Reconciliation Program Manager
Mass General Brigham Health Plan
-
Somerville, MA
Responsible for ensuring all 834 transactions are being correctly reconciled. Work closely with IT to set requirements and user stories, as well as signing off on results and approving changes being promoted to production. Lead teams to enable system automation in Enrollment to reduce administrative costs, improve member experience and operational efficiency. Engage, empo
Email Job
Posted 16 days ago
Medical Letter Writer
Mass General Brigham Health Plan
-
Somerville, MA
This is a remote role with occasional (roughly 1x/every other month) onsite team meetings in Somerville, MA. 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
Email Job
Posted 19 days ago
Senior Product Manager
Mass General Brigham Health Plan
-
Somerville, MA
This is a hybrid role that will require an onsite presence to the office 1x/month 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 sol
Email Job
Posted 19 days ago
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