Claims Review Specialist, DSNP
This is the employer's own posting, not a copy on a job board.
What we know
Is it still open?
Confirmed still open
Last checked 1d ago — checked against the employer's own applicant tracking system, which is the company answering directly.
We re-read the employer's own applicant tracking system and the posting was still there. That is the company answering directly.
How old is it?
Posted 39d ago
The date the source published, not the day we noticed it (2026-08-24). Last seen at its source 2h ago.
We have tracked this listing since 23 Sep 2026 (9 days). The employer's own board has carried it every time we have read it, most recently 2 hours ago.
Is it remote?
The listing says yes
The location field doesn't say remote, so our assessment is based on the title or the description. Read the listing before applying.
Who may apply?
Not stated
The description states no restriction of its own. This is the source's own tag.
Pay
$18–25/hr
Read out of the job description by us, not from a structured field. Shown in the posting's own currency and period; we never convert.
Skills named in the ad
Recognised terms only, from a fixed vocabulary — this is what CV matching compares against.
Carried by 1 source
-
workday employer's own board first seen 9d ago · last seen 2h ago
The listing
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
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.
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. The ideal candidate brings hands‑on experience with SCO and One Care claims processing and demonstrated proficiency in QNXT or similar claims adjudication systems (e.g., Facets).
Essential Functions:
• Adjudicate claims to pay, deny, or pend as appropriate in a timely and accurate manner according to company policy and desktop procedure.
• Review and research assigned claims by navigating multiple systems and platforms, then accurately capturing the data/information necessary for processing (e.g., verify pricing/fee schedules, contracts, Letter of Agreement, prior authorization, applicable member benefits).
• Manually enters claims into claims processing system as needed.
• Ensure that the proper benefits are applied to each claim by using the appropriate processes and desktop procedures (e.g., claims processing policies, procedures, benefits plan documents).
• Communicate and collaborate with external department to resolve claims errors/issues, using clear and concise language to ensure understanding.
• Learn and leverage new systems and training resources to help apply claims processes/procedures appropriately (e.g., online training classes, coaches/mentors).
• Meet the performance goals established for the position in areas of productivity, accuracy, and attendance that drives member and provider satisfaction.
• Create/update work within the call tracking record-keeping system.
• Adhere to all reporting requirements.
• Keep up to date with Desktop Procedures and effectively apply this knowledge in the processing of claims and in providing customer service.
• Identify and escalate system issues, configuration issues, pricing issues etc., in a timely manner.
• Process member reimbursement requests as needed.
Qualifications
Education
- High School Diploma or Equivalent required; Associate's degree preferred
Experience
- Related Healthcare Experience 1-2 years required
- At least 2-3 years of previous experience in the health insurance industry in functions such as claims processing highly preferred
- SCO and OneCare claims processing experience highly preferred
Knowledge, Skills, and Abilities
- Knowledge of healthcare claims processes for (D-SNP/fully-integrated Medicare & Medicaid/Mass Health highly preferred.
- Knowledge of ICD-10, HCPCS, CPT-4, and Revenue Codes highly preferred
- Knowledge of medical terminology highly preferred.
- Familiarity with insurance plans, government programs, and their billing requirement preferred.
- Knowledge of claim forms (professional and facility) highly preferred
- Professional Coder Certificate is highly desirable
- Strong customer service orientation and ability to handle sensitive or difficult situations with empathy and professionalism.
Additional Job Details (if applicable)
Working Condition
- This is a remote role that can be done from most US states
- This is a full-time schedule (Monday through Friday, 8-4:30 pm or 8:30-5:00 pm ET)
- Remote workdays require a stable, secure, quiet, and HIPAA-compliant workspace. This will be confirmed via Microsoft Teams video for all employees
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$17.71 - $25.28/Hourly
Grade
2
EEO Statement:
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.