Supervisor of DSNP Claims

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.

Job Summary

Responsible for overseeing a team that assesses healthcare (D-SNP / fully-integrated Medicare & MassHealth / Medicaid) claims for accuracy, compliance, and eligibility, ensuring that claims are processed efficiently and in accordance with industry standards, Medicare and MassHealth / Medicaid regulatory requirements, and organizational policies. This position will guide and support the D-SNP claims review team, handle escalations, and collaborate with other departments to improve claims processing and ensure timely reimbursements.

Essential Functions

• Supervise and manage a team of D-SNP claims reviewers to ensure accurate and timely healthcare D-SNP / fully-integrated Medicare & MassHealth / Medicaid claims processing.
• Oversee D-SNP claims review and analysis to ensure compliance with Medicare and MassHealth / Medicaid regulations, payer requirements, and organizational policies.
• Resolve escalated or complex D-SNP 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 D-SNP claims review process for greater accuracy and efficiency.
• Collaborate with billing, coding, and compliance teams to ensure adherence to Medicare and MassHealth / Medicaid regulatory and payer standards.
• Analyze D-SNP 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.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

Education

Experience

Knowledge, Skills, and Abilities

Additional Job Details (if applicable)

Working Conditions

Pay Range

$78,000.00 - $113,453.60 / Annual

Grade

EEO Statement

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 (857)-282-7642.

Mass General Brigham Competency Framework

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.