Medicare / Medicaid Claims Reimbursement Specialist

Claims Sr. Analyst

This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this time.

Position Summary :

Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, and timely reimbursements within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director of Claims Operations and Quality Assurance, this role is responsible for the end-to-end review, analysis, and resolution of complex reimbursement issues including underpayments, overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial payment methodologies and supports audit, compliance, and provider engagement initiatives. This role also provides support in managing provider disputes and escalations requiring detailed pricing and reimbursement validation.

Supervision Exercised :

• No, this position does not have direct reports.

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