Claims Production Specialist

🔥 5 minutes ago

🦌 Connecticut, Massachusetts – Remote

🦌 Connecticut – Remote 🍂 Massachusetts – Remote

💵 $23 - $31 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Baystate Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1873

🏥 Healthcare

🧘 Wellness

📚 Education

Healthcare • Wellness • Education

Baystate Health is a regional integrated health system serving western Massachusetts, providing hospital-based and outpatient care including emergency services, primary and specialty care, surgery, oncology, cardiology, pediatrics, radiology, and maternal health. It operates multiple hospitals and clinics, runs community health and wellness programs, conducts clinical research and trials, and serves as the regional campus for UMass Chan Medical School with extensive medical education and residency programs. Baystate also offers patient-facing digital tools (MyBaystate), fundraising through a foundation, and community outreach and volunteer initiatives.

📋 Description

• Review and finalize medical claims, adjustments, and retractions according to established policies and procedures • Investigate pending claims, research discrepancies, and coordinate with claims adjudication partners and vendors • Meet productivity and accuracy goals • Identify unusual claims trends, processing variations, and potential issues, escalating findings to senior team members • Collaborate with Senior Claims Production Specialists, Finance, ASO, and external vendors to resolve claims issues and process provider refunds • Manage incoming claims inquiries and requests within established timelines • Maintain confidentiality and follow regulatory requirements

🎯 Requirements

• 3+ years of experience in healthcare claims administration, medical claims processing, provider billing, or provider payment posting and reconciliation • High school diploma or equivalent • Knowledge of medical coding and billing methodologies, including CPT-4, ICD-10, UB-04, and HCFA-1500 • Familiarity with HIPAA, ACA, CMS, MassHealth, and ERISA • Experience with claims processing systems, medical claims editing platforms, or medical pricing tools • Strong analytical, critical-thinking, and problem-solving skills • Excellent communication and collaboration skills • Proficiency in Microsoft Word, Excel, and Outlook • Commitment to accuracy, confidentiality, compliance, and continuous learning • Candidate must live in Massachusetts or Connecticut

🏖️ Benefits

• Full-time schedule, Monday through Friday, 7:00am–3:30pm • No weekends • No holidays • Fully remote opportunity