Help strengthen relationships with healthcare providers and ensure accurate claims processing across WellSense’s Medicare, Medicaid, and commercial networks.
About WellSense Health Plan
WellSense is a nonprofit health plan serving more than 740,000 members across Massachusetts and New Hampshire. For over 25 years, we’ve delivered accessible, high-quality Medicare, Medicaid, and Individual/Family coverage. Our mission is to make healthcare work for everyone, regardless of circumstance.
Schedule
• Full-time
• Remote role with travel requirements
• Up to 50% travel to local communities for provider meetings
• Fast-paced workload with cross-department collaboration
Responsibilities
• Investigate, document, track, and help resolve provider claim issues
• Partner with Claims, Benefits, Enrollment, Audit, and Clinical Services to ensure timely and accurate claim payments
• Identify system changes impacting claims and collaborate internally to drive solutions
• Analyze claims processing trends and assist with issue quantification
• Run claim reports to support provider visits and outreach
• Strengthen relationships with physicians, clinicians, community health centers, and hospitals
• Serve as the primary contact for provider reimbursement questions and issue resolution
• Provide education to providers on WellSense products, policies, procedures, and operational processes
• Communicate Plan updates and ensure smooth information flow across departments
• Conduct outreach aligned with Plan initiatives
• Facilitate interdepartmental coordination to resolve complex provider issues
• Research provider data discrepancies in Onyx and Facets and request system updates when needed
• Support credentialing, servicing, and recruitment through report preparation
• Ensure compliance with NCQA and state agency requirements
• Other duties as assigned
• Maintain regular, reliable attendance
Requirements
Education
• Bachelor’s degree in Business Administration or related field, or equivalent experience
Experience
• 2 or more years in managed care or healthcare preferred
• Understanding of Medicare and Medicaid reimbursement methodologies
• Familiarity with provider coding and billing practices
• Experience with ICD-10, CPT/HCPCS, and claim form standards
Skills & Competencies
• Strong communication skills, written and verbal
• Proven ability to manage multiple priorities with strong follow-up habits
• High proficiency with Microsoft Office
• Strong organizational and independent problem-solving skills
• Ability to work collaboratively with teams and external partners
Additional Requirements
• Valid driver’s license and access to a vehicle
• Pre-employment background check
Benefits
• Competitive salary
• Full medical, dental, vision, and pharmacy coverage
• 403(b) retirement plan with employer match
• Paid time off and wellness support
• Flexible Spending Accounts
• Career development opportunities
• Full-time remote flexibility with community-based travel
If you’re a detail-oriented relationship builder who can navigate claims, coding, reimbursement, and provider engagement with confidence, this role is built for you.
Happy Hunting,
~Two Chicks…