Claims Review Specialist, Dsnp

Mass General Brigham Health Plan Holding Company, Inc.

Somerville, MA, United States
Base: $17.71 - $25.28phly; bonus/equity: not speci...
Fully remote
Sco and one care claims processing
Qnxt or similar claims adjudication systems
Review and research assigned claims
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.
  • The Specialist ensures claims are adjudicated accurately, timely, and in compliance with Mass General Brigham Health Plan administrative policies, operational procedures, and clinical guidelines.
  • 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
  • Review and research assigned claims
  • Apply proper benefits to claims
  • Communicate and collaborate with external department

Nice-to-have

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

Key Requirements

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

Work Rights

Not specified

Tailored Resume

Cover Letter