New

Claims Operations Manager

Mass General Brigham Health Plan
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Oct 28, 2025
The Opportunity The Claims Operations Manager is responsible for managing claims operations to ensure efficient and accurate processing of claims. Oversees claims workflows, compliance, and team performance to support revenue cycle goals and optimize reimbursement processes. Responsible for planning, directing, and coordinating the day-to-day operations of the Claims Operations teams (including the claims reviewer team and the resolution team), ensuring that all metrics are achieved for quality, time, inventory, and aging for original claims and provider correspondence. Essential Functions -Monitors accurate reporting of claim key metrics including but not limited to claim turnaround times, denial rates, quality scores, claims over 30 and 45 days, customer service statistics, call tracking and correspondence inventories and turnaround, data entry numbers, and turnaround time. -Set clear goals and objectives and use metrics to measure performance and hold staff accountable. -Provide coaching to improve performance and hold regular development. -Leads the claims operations team, including hiring, training, and performance management. -Oversees the processing and submission of claims to ensure accuracy, timeliness, and compliance with payer requirements. -Monitors claim metrics to identify trends, reduce denials, and improve revenue cycle performance. -Implements and updates policies and procedures to align with regulatory standards and organizational goals. -Collaborates with billing, coding, and clinical teams to address claims issues and resolve discrepancies. -Manages relationships with insurance payers to streamline claims adjudication and reimbursement processes. -Prepares and presents performance reports and improvement strategies to hospital leadership. Bachelor's Degree Healthcare Administration required, or bachelor's degree Business Administration required, or bachelor's degree in a related field of study required Can this role consider and review experience in lieu of a degree? Yes Certified Professional Coding - Preferred Experience in claims management or revenue cycle operations 5-7 years required and Experience in a supervisory or leadership role 2-3 years required Skills For Succes Thorough knowledge of claims processes, insurance requirements, and healthcare regulations. Strong leadership and team management abilities. Proficiency in claims processing systems and revenue cycle management tools. Excellent analytical skills to assess and improve claims performance metrics. Effective communication and interpersonal skills for collaboration and issue resolution. Ability to manage multiple priorities in a fast-paced and dynamic healthcare environment. Experience in automation implementation and leveraging AI technology to streamline business processes. Attention to detail and a commitment to maintaining compliance and accuracy. Working Model Requirements Hybrid role M-F Eastern Business Hours Quarterly meetings onsite as planned for business and team needs, must be flexible On remote workdays, employee must have a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment. Mass General Brigham Health Plan Holding Company, Inc. 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 law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.