Supervisor Claims Reviewer
Mass General Brigham Health Plan

Job Info

---

As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.

We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step.

Our employees use the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.

The Claims Review Supervisor plans, directs, and coordinates the work of the Commercial Claims Review Team. Supervises 7-8 staff members, ensuring performance standards are met through monitoring of productivity and quality reports.

Primary Responsibilities:

• Select, train, motivate, develop and evaluate staff in compliance with established policies, practices and procedures.
• Set and approve work schedules, time off requests, overtime and approve timecards.
• Schedule staff for needed training and development.
• Mentor and coach the claims staff regarding policies, procedures, processing techniques and performance.
• Responsible for Performance Management in compliance with company policy up to and including termination.
• Plan and facilitate regular bi-weekly team and one on one meetings; keeping employees up to date and well informed of company and departmental activities/ happenings.
• Supervise and provide guidance to the work of the review team ensuring service, quality and productivity standards are met.
• Run and analyze reports to manage the inventory of claims and correspondence.
• Distribute work taking into account department metrics.
  
• Review aging and inventory of work and maintain at acceptable levels; prioritize the type of work based on the inventory and when necessary, escalate.
• Research and find solutions for issues escalated or delegated from team members, internal customers, or Manager.
• Ensure daily productivity reports are produced, maintained and distributed to direct reports.
• Provide routine and special reports on claims identifying patterns and trends. Analyze those trends for provider education, desktop update or other appropriate actions.
• Performs check run validation procedures and make necessary corrections to ensure a successful claims check run.
• Recommend changes in claims operations policies and procedures and give input to desktop procedures.
• Identify/request as needed clarification and or updates to policies and procedures.
• Recommends and participates in development and implementation of departmental work standards, policies and procedures.
• Assist in testing new processes, system updates and upgrades.
• Assist with centralized training.
• Identify and provide claim scenarios.
• Co-facilitate training sessions as needed.
• Identify systemic issues and trends and work with issue owners to find resolution.
• Hold self and others accountable to meet commitments.
• Build strong customer relationships and deliver solutions that meet customer expectations; establish and maintain effective customer relationships - both internal as well as external.

Qualifications
Basic Requirements:

• Bachelor's Degree or the equivalent combination of training and experience
• 5+ years of health care claim processing experience of which 2 should have been in a leadership/supervisory role.

Preferred Qualifications:

• Strong supervisory skills
• Ability to coach, mentor, train, develop and motivate employees in a team environment.
• Highly organized with the ability to prioritize and multi-task.
• Strong analytic, critical thinking and problem-solving skills.
• Strong learning skills and mental agility
• Excellent verbal and written communication skills
• Exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
• Strong interpersonal skills with the ability to work well with people, building solid interdepartmental relationships.
• Excellent customer service skills
• Maintains confidentiality.
• Demonstrate MGBHP Core Values of Accountability, Service Excellence, Quality Care, Diversity, and forging strong Relationships.
• Respect the talent and unique contribution of every individual, culture and ethnic group and treat all people in a fair and equitable manner.
• Exercise self-awareness; monitor impact on others; is receptive to and seek out feedback; use self-discipline to adjust to feedback.
• Accountable for delivering high quality work. Act with a clear sense of ownership.
• Certified Professional Coder experience

EEO Statement
Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. 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 the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.

---