Claims Production Specialist

Baystate Health

. Review and finalize medical claims, adjustments, and retractions according to established policies and procedures .

Posted 10/16/2026full-timeRemote • United StatesMid-LevelSenior💰 $23 - $32 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in healthcare claims administration, including medical claims processing and provider billing, while ensuring compliance with regulatory requirements such as HIPAA and ACA. Strong analytical and problem-solving skills are essential for identifying trends and resolving claims issues effectively.

Highest-signal resume keywords

Healthcare Claims AdministrationMedical Claims ProcessingKnowledge of CPT-4, ICD-10, UB-04, HCFA-1500Claims Processing Systems ExperienceStrong Analytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical CodingClaims AdjustmentsClaims RetractionsProvider BillingProvider Payment PostingClaims Discrepancy ResearchClaims Trends IdentificationProductivity Goals AchievementAccuracy Goals AchievementRegulatory Compliance

Soft Skills

Critical-ThinkingProblem-SolvingCommunicationCollaborationCommitment to Continuous Learning

Tools & Technologies

Claims Processing SystemsMedical Claims Editing PlatformsMedical Pricing ToolsMicrosoft WordMicrosoft ExcelMicrosoft Outlook

Industry Keywords

HIPAAACACMSMassHealthERISA

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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