Claims Review Specialist, DSNP — Mass General Brigham Health Plan
Mass General Brigham Health Plan
Pay$17.71-$25.28
LocationRemote - Most U.S. States
Remote statusRemote
Phone levelLow phone
IndustryHealth Insurance / Managed Care
OccupationClaims Review Specialist
Job functionD-SNP Medicare/Medicaid Claims Adjudication
State restrictionsMost U.S. states; Tennessee is included in published eligible-state lists
Eligible countriesUnited States
RegionNorth America
Job Summary
Manually reviews and adjudicates SCO and One Care claims that do not auto-adjudicate, researches pricing, contracts, authorizations and benefits, and processes claims to pay, deny or pend.
Job Description
Manually reviews and adjudicates SCO and One Care claims that do not auto-adjudicate, researches pricing, contracts, authorizations and benefits, and processes claims to pay, deny or pend.
Additional Requirements & Compensation
Work authorizationNot specified
LanguageStrong written and verbal English communication
Time zoneMonday-Friday 8:00-4:30 PM or 8:30-5:00 PM Eastern
Additional Job Details
- High school diploma/equivalent required
- associate degree preferred. Requires 1-2 years of related healthcare experience
- 2-3 years health-insurance claims and SCO/One Care experience are highly preferred. QNXT or similar systems preferred.
Posting Information
Posted date2026-09-21