Claims Review Specialist, Dsnp

Mass General Brigham Health Plan Holding Company, Inc.

Boston, Massachusetts, USA
Base: $17.71 - $25.28phly; bonus/equity: not speci...
Fully remote
Sco and one care claims processing
Qnxt or similar claims adjudication systems
Adjudicate claims to pay, deny, or pend
The D‑SNP Claims Review Specialist reviews and processes Senior Care Options (SCO) and One Care medical claims requiring manual intervention when auto‑adjudication is not achieved

Job Summary

  • The D‑SNP Claims Review Specialist reviews and processes Senior Care Options (SCO) and One Care medical claims requiring manual intervention when auto‑adjudication is not achieved.
  • Mass General Brigham Health Plan is at the forefront of transformation with one of the world’s leading integrated healthcare systems, providing innovative solutions centered on member health needs.
  • We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.

Matching Summary

The D‑SNP Claims Review Specialist reviews and processes Senior Care Options (SCO) and One Care medical claims requiring manual intervention when auto‑adjudication is not achieved.

Salary

Base: $17.71 - $25.28/Hourly; Bonus/Equity: Not specified; Benefits: Comprehensive benefits package

Skills & Requirements

Must-have

  • SCO and One Care claims processing
  • QNXT or similar claims adjudication systems
  • Adjudicate claims to pay, deny, or pend
  • Review and research assigned claims
  • Communicate and collaborate with external department

Nice-to-have

  • Strong customer service orientation
  • Handle sensitive or difficult situations
  • Embraces unique and varied backgrounds

Key Requirements

  • Associate's Degree Healthcare Management preferred
  • Related Healthcare Experience 1-2 years
  • 2-3 years health insurance industry experience
  • SCO and OneCare claims processing experience
  • Knowledge of ICD-10, HCPCS, CPT-4, and Revenue Codes
  • Knowledge of medical terminology
  • Professional Coder Certificate is highly desirable

Work Rights

Not specified

Tailored Resume

Cover Letter