Top 434 Claims manager Jobs in Massachusetts

Contract Manager - Hosp/Physician group exp a plus - Hybrid schedule
Fallon Health —Worcester, MA
- Full-time
- Hybrid work
- Clean driving record
- Research
- Mid-level
14d
Supervisor, Casualty Claims (Hybrid, Webster)
MAPFRE —Webster, MA
- $77,700 - $111,900 a year
- 7 years
- Computer literacy
- Math
- Profit sharing
- Health savings account
Team Manager - Claims - Bridgewater Office
Arbella Insurance Group —Bridgewater, MA
- $90,000 - $130,000 a year
- Full-time
- Writing skills
- Office
- Mentoring
Case Manager RN - Work From Home - EST
CVS Health —Massachusetts
- $66,575 - $142,576 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Surgery
- Health insurance
- Dental insurance
5d
Risk Manager
Dana-Farber Cancer Institute —Brookline, MA
- $120,100 - $138,200 a year
- Full-time
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
Claims Manager I, Miscellaneous Medical Facilities Professional Liability
Liberty Mutual —Boston, MA
- $120,000 - $225,000 a year
- Urgently hiring
- Remote
- Office
- Bachelor's degree
- Organizational skills
Compliance Program Manager (Operations and Investigations)
Philips —Cambridge, MA
- $125,000 - $198,000 a year
- Full-time
- Microsoft Access
- 5 years
- Office
- Health savings account
- Employee stock purchase plan
7d
Senior Risk Manager
National Fire Protection Association —Quincy, MA
- $118,478 - $201,445 a year
- Full-time
- Remote
- 7 years
- Public speaking
- Office
Engineering Manager, Claims Technology
Berkshire Hathaway Specialty Insurance —Boston, MA
- $150,000 - $180,000 a year
- Office
- 3 years
- Mentoring
- Paid parental leave
- AD&D insurance
Quick Apply
Safety Manager
Casella Waste Systems, Inc. —Auburn, MA
- $92,700 - $121,700 a year
- Full-time
- Clean driving record
- Ability to walk for extended periods
- 5 years
Quick Apply
Manager EH&S
Stanley Black & Decker —Holliston, MA
- $95,600 - $153,900 a year
- Full-time
- 5 years
- Bachelor's degree
- Senior level
- Wellness program
- Employee stock purchase plan
Recycling Operations District Manager
Radius Recycling, Inc. —Attleboro, MA
- $145,000 a year
- Overtime
- Background check
- 18 years or older
- 5 years
- Paid holidays
- Health insurance
Quick Apply
Safety and Risk Manager
Schernecker Property Services —Needham Heights, MA
- $120,000 - $130,000 a year
- Full-time
- Hybrid work
- CPR Certification
- Mid-level
- Analysis skills
- Health savings account
- Health insurance
Quick Apply
Manager, Compliance (Hybrid -Acton, MA)
Insulet Corporation —Acton, MA
- $110,300 - $165,500 a year
- Full-time
- Hybrid work
- 5 years
- HIPAA
- Office
- Health insurance
- Dental insurance
Product Manager, Claims Pricing & Financial Operations
Rxadvance Corporation —Southborough, MA
- $110,000 - $170,000 a year
- Full-time
- Background check
- 5 years
- No experience needed
Quick Apply
Patient Safety Risk Manager, RN
Beth Israel Lahey Health —Boston, MA
- $76,960 - $199,129 a year
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Fleet Manager, Boston EMS
Boston Public Health Commission —Boston, MA
- $1,270.81 - $1,856.96 a week
- Monday to Friday
- 5 years
- Windows
- Driver's License
Travel Manager
Anduril Industries —Boston, MA
- $112,000 - $149,000 a year
- Email
- Mid-level
- Office
- Microsoft Office
Quick Apply
Learning and Development Supervisor
Plymouth Rock Assurance Corporation —Boston, MA
- $114,000 - $147,000 a year
- 5 years
- Bachelor of Science
- Office
- Paid holidays
- Disability insurance
Quick Apply
Customer Success Manager - P&C Claims
Shift Technology —Boston, MA
- $120,000 - $140,000 a year
- Full-time
- Remote
- Mid-level
- Training & development
- Internship
- Paid holidays
- Paid time off
Quick Apply

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claims manager jobs near massachusetts

Contract Manager - Hosp/Physician group exp a plus - Hybrid schedule

Fallon Health -
Worcester, MA

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Job Details

Full-time
14 days ago

Qualifications

Managed care organization experience
Presentations for conferences or internal meetings
Employee relationship building
Driver's License
Computer skills
Stakeholder relationship building

Full Job Description

Overview:

About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief Summary of purpose:

Responsible for the analysis, negotiation/renegotiation, implementation, readjustment, evaluation, and continuous improvement of all functions of provider contracting. Manages financial and operational issues related to contractual provider arrangements. Responds to both internal and external customers regarding provider contractual arrangements, both for contract implementation and ongoing operations.

Responsibilities:

Primary Job Responsibilities:

Negotiates, develops and designs contractual provider (Hospital and physician) arrangements including language and pricing methodologies.
Evaluates contractual payment methodologies in order to determine financial risk to insurer and provider (per diem, capitation, discount from charge, DRG, case rate, bundled payments, pay for performance programs, etc.). Ensures the design, production, and distribution of site financial, utilization and member information; ensures the production and completeness of annual site settlement reports. Interfaces between the Plan’s Finance department and individual sites for budget, financial reporting and settlement arrangements for all relevant products.
Performs quantitative analyses of various financial and clinical data in order to evaluate multiple contracting options. Reports on performance of ongoing contractual arrangements to appropriate parties.
Manages, coordinates and resolves operational issues related to specific areas of responsibility. Serves as contact person for internal departments (i.e. Claims, Finance, Care Management Services, Patient Relations, Marketing, Credentialing, Provider Relations, etc.).
Researches, analyzes and presents recommendations to Manager regarding contractual and financial decisions.
Manages provider correspondence relating to contracts and responds to requests from potential new providers for FCHP.
Maintains computerized tracking system for new and revised agreements. Coordinates and communicates contractual information to appropriate departments within FCHP.
Maintains assigned provider network; physician, hospital, ancillary, and/or carve out vendor as assigned by Director or Manager.
Prepares, updates and maintains files and database for all assigned provider contracts.
Serves as committee member in cross-functional teams as assigned by Director or Manager.
Assists in Provider Relations activities including servicing, educating and distributing information to contracted providers.
Analyzes and presents financial reports to providers. Makes recommendations to providers regarding quality and cost improvements.
Other duties as assigned.

Additional Performance Requirements:

Must be a team player with strong relationship building skills.
Must be able to prepare and conduct formal presentations to small and large audiences both internally and externally

Qualifications:

Education:

Bachelor’s degree or equivalent experience required.

Master’s degree in Business Administration, Healthcare Administration, or Public Health preferred. Previous background in nursing or any allied health field is often valuable but not required

License/Certifications

Valid Driver’s License and Clean Driving Record Required

Experience:

Minimum of three years experience in managed healthcare environment(s) with related work in provider contracting, healthcare finance, provider reporting/profiling, and/or provider relations. Experience in provider contract negotiations, including FFS, capitation models, Hospital contracts and pay for performance models is preferred. Excellent analytical, strategic thinking, and creative thinking skills are required. Superior verbal and written skills, excellent computer skills (Word, Excel, Access) are essential to this position.

Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $100,00-$120.000 annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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Refine Your Search

claims manager jobs in massachusetts

Contract Manager - Hosp/Physician group exp a plus - Hybrid schedule

Supervisor, Casualty Claims (Hybrid, Webster)

Team Manager - Claims - Bridgewater Office

Case Manager RN - Work From Home - EST

Risk Manager

Claims Manager I, Miscellaneous Medical Facilities Professional Liability

Compliance Program Manager (Operations and Investigations)

Senior Risk Manager

Engineering Manager, Claims Technology

Safety Manager

Manager EH&S

Recycling Operations District Manager

Safety and Risk Manager

Manager, Compliance (Hybrid -Acton, MA)

Product Manager, Claims Pricing & Financial Operations

Patient Safety Risk Manager, RN

Fleet Manager, Boston EMS

Travel Manager

Learning and Development Supervisor

Customer Success Manager - P&C Claims

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