Claims investigator Jobs in Springfield, MA

Essential Duties and Responsibilities :

• Act as lead technical representative and spokesperson supporting pre-marketing and proposal activities.
• Frequently responsible for providing guidance, coaching, and training to other employees across the organization within area of expertise.
• Drive the decision making for technical decisions in conjunction with systems technical staff.
• Document technical strategies to facilitate operational business needs.
• Assess systems requirements and design against best practices, technology advances, industry standards, and business needs.
• Provide direction on implementing feasible, cost-effective solutions to the overall system architecture and design to meet these needs.
• Review systems functionality, performance, and reliability to determine fit with business needs.
• Identify gaps and propose strategic technical solutions to implement solutions.
• Review federal, state, and company policies to determine applicability to systems functionality, design, and operation.
• Develop strategies to fulfill requirements and assess effectiveness of implementation.
• Design, develop, and maintain operational, analytical, and regulatory reports using SSRS, Bold BI, and other BI / reporting tools
• Create parameterized, drill-down, and user-friendly reports for diverse audiences
• Ensure reports are accurate, timely, and aligned with Medicaid business and reporting needs
• Maintain report catalogs, documentation, and version control
• Develop reports supporting Medicaid operations, such as claims, encounters, eligibility, provider, care management, and utilization
• Support regulatory and compliance reporting requirements, including CMS and state Medicaid submissions
• Partner with business and compliance teams to interpret reporting specifications and translate them into report logic
• Validate data outputs and reconcile results against source systems and expectations
• Write and optimize SQL queries and stored procedures to support reporting needs
• Collaborate with data engineers, analysts, and business stakeholders to clarify requirements
• Participate in testing, peer reviews, and quality assurance of reporting outputs
• Provide end-user support, enhancements, and minor modifications to existing reports

Minimum Requirements

• Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.

Required Qualifications

• Bachelor's degree
• 5+ years of experience developing reports in a healthcare environment
• Strong hands-on experience with SSRS and at least one modern BI tool (e.g., Bold BI, Power BI, Tableau)
• Advanced SQL skills (queries, joins, aggregations, performance tuning)
• Experience reporting on Medicaid data domains (claims, encounters, eligibility, provider, or quality data)
• Strong attention to detail and commitment to data accuracy
• Ability to communicate technical concepts clearly to non-technical users

Preferred Qualifications

• Experience supporting state Medicaid agencies or Medicaid Managed Care Organizations (MCOs)
• Experience with regulatory reporting and quality measures
• Knowledge of healthcare data privacy and security principles (HIPAA)
• Experience gathering requirements directly from business or compliance stakeholders

EEO Statement

Maximus is an equal opportunity employer.

We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.

Annual salary is just one component of Maximus's total compensation package.

Other rewards may include short- and long-term incentives as well as program-specific awards.

Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off.

Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience.

An applicant's salary history will not be used in determining compensation.

Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.

Accommodations

Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment.

If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at applicantaccom@maximus.com.

Minimum Salary

125,000.00

Maximum Salary

170,000.00