Claims Team Lead
3 weeks ago
Job Description - Claims Team Lead (3290186) Job Number: Claims Team Lead (3290186) Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on 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 consciously inclusive environment where diversity is celebrated. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. The Claims Team Lead researches and resolves disputes (contracts, corrected claims, filing limits, authorization and payer policy etc.) for providers, members and internal customers; coaches and mentors claims resolution coordinators, manages and distributes work as designated, and assists with centralized and on the job training. The Claims Reviewer Team Lead serves as a backup to the claim's supervisor for all essential functions. This is a hybrid role requiring an onsite presence to the Somerville office 1x/month. Responsibilities: Manage and distribute work as designated Run and analyze reports Review aging and inventory levels Hold self and others accountable to meet commitments Assist in testing new processes, system updates and upgrades Identify and provide claim scenarios for testing when needed Assist in the development, implementation, and delivery of training Functions as coach, mentor and role model to staff Establish and maintain effective customer relationships with internal stakeholders; Serve as liaison with other departments Serve on Desktop committee for the creation, updating and approval of desktop procedures Identify opportunities for process improvement and make recommendations Perform special projects as needed Review, research and resolve the more difficult claims, call tracking and correspondence by navigating multiple systems and platforms and accurately capturing the data/information necessary for processing (e.g. verify pricing/Fee Schedules, contracts and Letters of Agreement, prior authorizations, applicable member benefits) Create/update, work and close Call tracking records in record keeping system Communicate and collaborate with other departments to resolve claims errors/issues, using clear, simple language to ensure understanding within the service level agreement Learn and leverage new systems and training resources to help apply claims processes/procedures appropriately (e.g. on-line training classes, coaches/mentors) Request clarification and or updates to policies and procedures as needed Keep up to date with desktop procedures, payment policy guidelines, benefit updates, authorization rules and effectively apply this knowledge in the processing of claims and in providing customer service Identify and escalate issues – systemic, configuration, pricing, etc., to attention of supervisor/manager in a timely manner Required Qualifications: Bachelor degree or the equivalent combination of training and experience 3 – 5+ years of health care claims processing experience Strong leadership skills Organized with the ability to prioritize and multi-task Excellent verbal and written communication skills Highly motivated Ability to work independently Strong ability to hold information confidential Demonstrate Mass General Brigham Health Plan 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. Knowledge of ICD-10, HCPCS, CPT-4, and Revenue Codes. Knowledge of medical terminology Knowledge of claim forms (professional and facility) Knowledge of Home Infusion Claim Processing preferred Knowledge of paper vs. electronic filing and medical billing guidelines preferred Completion of coding classes from certified medical billing school preferred #J-18808-Ljbffr
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Claims Team Lead
3 weeks ago
Somerville, United States Brigham and Women's Hospital Full timeJob Description - Claims Team Lead (3290186) Job Number: Claims Team Lead (3290186) Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members...
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Claims Team Lead
3 weeks ago
Somerville, United States Brigham and Women's Hospital Full timeJob Description - Claims Team Lead (3290186) Job Number: Claims Team Lead (3290186) Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the worlds leading integrated healthcare systems. Together, we are providing our members with...
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Claims Team Lead
3 weeks ago
Somerville, United States Mass General Brigham Health Plan Full time- (3290186) Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on 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...
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Claims Team Lead
3 weeks ago
Somerville, United States Mass General Brigham Health Plan Full time- (3290186) Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on 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...
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Claims Team Lead
4 weeks ago
Somerville, Massachusetts, United States Mass General Brigham Health Plan Full timeJob SummaryMass General Brigham Health Plan is seeking a highly skilled Claims Team Lead to join our team. As a key member of our claims resolution team, you will be responsible for researching and resolving disputes, coaching and mentoring claims resolution coordinators, and managing and distributing work as designated.Key ResponsibilitiesManage and...
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Sales Team Lead
4 weeks ago
Somerville, Massachusetts, United States Levi Strauss & Co. Full timeJob SummaryAs a Sales Supervisor at Levi Strauss & Co., you will be responsible for leading a team of retail sales associates and ensuring excellent customer service and satisfaction.Key ResponsibilitiesSupervise and lead a team of retail sales associates to achieve sales targets and provide excellent customer service.Monitor and analyze sales performance...
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Sales Team Lead
4 weeks ago
Somerville, Ohio, United States Steve Madden Full time**Job Summary**As a Sales Supervisor at Steve Madden, you will be responsible for supervising an assigned work schedule in the absence of the Store Manager. This includes assisting in all aspects of store operations, maintaining sales productivity levels, and staying up-to-date on product knowledge information and merchandise promotions.**Key...
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Administrative Assistant
2 weeks ago
Somerville, United States Lead Advisor LLC Full timeLead Advisor, LLC is a wealth management consulting and search firm. This role is for one of our clients. To see other roles go to jobs.lead-advisor.com.Our client an established Wealth Management and Tax Firm is seeking an Administrative Assistant to join their team. The ideal candidate will possess strong communication skills, be proficient in various...
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Administrative Assistant
2 weeks ago
somerville, United States Lead Advisor LLC Full timeLead Advisor, LLC is a wealth management consulting and search firm. This role is for one of our clients. To see other roles go to jobs.lead-advisor.com.Our client an established Wealth Management and Tax Firm is seeking an Administrative Assistant to join their team. The ideal candidate will possess strong communication skills, be proficient in various...
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Administrative Assistant
2 weeks ago
Somerville, United States Lead Advisor LLC Full timeLead Advisor, LLC is a wealth management consulting and search firm. This role is for one of our clients. To see other roles go to jobs.lead-advisor.com.Our client an established Wealth Management and Tax Firm is seeking an Administrative Assistant to join their team. The ideal candidate will possess strong communication skills, be proficient in various...
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Administrative Assistant
2 weeks ago
somerville, United States Lead Advisor LLC Full timeLead Advisor, LLC is a wealth management consulting and search firm. This role is for one of our clients. To see other roles go to jobs.lead-advisor.com.Our client an established Wealth Management and Tax Firm is seeking an Administrative Assistant to join their team. The ideal candidate will possess strong communication skills, be proficient in various...
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Clinical Operations Service Lead
1 month ago
Somerville, Massachusetts, United States Mass General Brigham Full timeMass General Brigham is seeking a highly skilled Clinical Operations Service Lead to join our Population Health Management team. As a key member of our team, you will provide administrative and operational support for a system-wide initiative focused on improving health equity for cardiometabolic disease and cancer screening.The ideal candidate will have a...
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Clinical Team Manager
1 month ago
Somerville, Massachusetts, United States Mass General Brigham Full timeMass General Brigham is seeking a highly skilled Clinical Team Manager to oversee the delivery of high-quality patient services in a home health setting. The ideal candidate will have a strong background in nursing and experience in managing clinical teams.Key Responsibilities:Manage staff assignments, caseloads, and productivity to ensure efficient and...
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Restaurant Team Member
4 months ago
Somerville, United States Loves Travel Stops & Country Store Full timeReq ID: 440893Address: 64 E. Pike Rd. Falkville, AL, 35622 Benefits: * Fuel Your Growth with Love's - company funded tuition assistance program * Paid Time Off * Flexible Scheduling * 401(k) – 100% Match up to 5% * Medical/Dental/Vision Insurance after 30 days * Competitive Pay * Career Development * Hiring Immediately Welcome to Love’s!Restaurant...
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Team Administrative Assistant
5 months ago
Somerville, United States Vinfen Full timeJob Description Schedule: Mon - Fri 9am - 5pm Salary: $ / hour Sign On Bonus: $1000; $500 to be paid upon completion of 30 days, $500 to be paid upon completion of 6 months The ACCS Administrative Assistant provides administrative and clerical support by implementing clerical and administrative systems to support team members in maintaining...
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Solutions Architect
3 weeks ago
Somerville, United States Mass General Brigham Health Plan Full timeDescription As a direct contributor with no direct reports, the Solutions Architect works closely with customers, business analysts, and team members to understand complex business requirements that drive the analysis and design of effective technical solutions for business processes. These solutions must be aligned with business and IT strategies and comply...
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Program Manager, Clinical Operations Service Lead
6 months ago
Somerville, United States Mass General Brigham Full timeProgram Manager, Clinical Operations Service Lead-(3292985) Description 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...
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Produce Associate Team Leader
1 month ago
Somerville, Massachusetts, United States Whole Foods Market Full timeJob SummaryWe are seeking a highly motivated and experienced Produce Associate Team Leader to join our team at Whole Foods Market. As a key member of our produce department, you will be responsible for assisting the Team Leader in all aspects of daily operations, including profitability, expense control, buying, merchandising, labor, regulatory compliance,...
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Somerville, United States Mass General Brigham (Enterprise Services) Full timeDescription 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...
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Somerville, Massachusetts, United States Whole Foods Market Full timeJob SummaryThis role involves leading the Meat & Seafood team to achieve sales, margin, and labor targets. The ideal candidate will have excellent leadership and communication skills, as well as experience in team building and employee relations.ResponsibilitiesDevelop and implement strategies to improve retail execution, productivity, and...
