Provider and Claims Operations Coordinator

Provider and Claims Operations Coordinator Location Hybrid remote in Quincy, MA :

This position will report to the Director of Provider Operations. This position will support the Directors of Provider and Claims Operations as well as other internal and external stakeholders such as EOHHS staff, providers, and vendors in the development, implementation, and ongoing activities that support the MassHealth provider experience and overall goals and objectives of MassHealth.

This position will assist the Directors of Provider and Claims Operations in the support of the MassHealth Business Support Services (BSS) contract and the Customer Service Center contract.

Areas of focus will be developing and analyzing various reports that will gauge the effectiveness and quality of activities performed by our MassHealth contracts as well as satisfaction of Providers and internal stakeholders. Assessing and supporting provider escalations and resolutions. Participating in the implementation of new MassHealth programs and the updating of current program policies and procedures. Participate in internal workgroups that support Provider and Claims Operations activities.

Duties and Responsibilities (these duties are a general summary and not all inclusive):

• Assist in establishing and maintaining relationships with our vendors, EOHHS staff and the MassHealth Provider community.
• Support BSS and Customer Service Center contracts by evaluating vendor reports, provider call experiences to determine trends, quality improvements, and overall provider experience.
• Participate in internal workgroups representing Operations subject matter expertise.
• Ability to create long and short-term plans that include, setting targets and adhering to deadlines.
• Assign and monitor projects and tasks assigned to internal and external parties

Required Qualifications:

• Ability to communicate effectively in oral expression and provide written and oral instructions
• Ability to analyze and determine the applicability of data, to draw conclusions, and make recommendations
• Knowledge of methods used in the preparation of charts, graphs, dashboards, and tables
• Experience with project plans
• Ability to successfully execute many complex tasks simultaneously
• Ability to adjust to varying or changing situations
• Strong proficiency in computer programs including; Microsoft office, word, excel, and Teams
• Proficient in analytic, interpersonal, and leadership skills

Preferred Qualifications:

• Knowledge and understanding of MassHealth programs and its provider community.
• Acquire an understanding of vendor contracts, it's policy and procedures, reporting capabilities and it's impact on the MassHealth provider experience.
• Understanding of MassHealth claims processing.
• Understanding of Provider and Claims Operations activities and their overall impact on MassHealth mission and goals

TO APPLY:

Please upload both Resume and Cover Letter for this position when applying. First consideration will be given to those applicants that apply within the first 14 days.

About MASSHEALTH:

To improve the health outcomes of our diverse members and their families by providing access to integrated health care services that promote sustainable & equitable health, well-being, independence and quality of life.

For more information about our agency and programs please visit:

Pre-Offer Process :

A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit

Education, licensure and certifications will be verified in accordance with the Human Resources Division's Hiring Guidelines.

Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth's website.

If you require assistance with the application/interview process and would like to request an ADA accommodation, please click on the link and complete the Reasonable Accommodation Online Request Form.

For questions, please the contact the Office of Human Resources at 1-800-510-4122 and select option #4.

Qualifications First consideration will be given to those applicants that apply within the first 14 days. MINIMUM ENTRANCE REQUIREMENTS: Applicants must have at least (A) four years of full-time, or equivalent part-time, professional, administrative or managerial experience in business administration, business management or public administration the major duties of which involved program management, program administration, program coordination, program planning and/or program analysis, and (B) of which at least one year must have been in a supervisory capacity, or (C) any equivalent combination of the required experience and the substitutions below. Substitutions: I. A Bachelor's degree with a major in business administration, business management or public administration may be substituted for a maximum of two years of the required (A) experience.* II. A Graduate degree with a major in business administration, business management or public administration may be substituted for a maximum of three years of the required (A) experience.* III. A Bachelor's or higher degree with a major other than in business administration, business management or public administration may be substituted for a maximum of one year of the required (A) experience.*

• Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed.

NOTE: No substitutions will be permitted for the required (B) experience.

Comprehensive Benefits

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

Want the specifics? Explore our Employee Benefits and Rewards!

Executive Order #595: As a condition of employment, successful applicants will be required to have received COVID-19 vaccination or an approved exemption as of their start date. Details relating to demonstrating compliance with this requirement will be provided to applicants selected for employment. Applicants who receive an offer of employment who can provide documentation that the vaccine is medically contraindicated or who object to vaccination due to a sincerely held religious belief may make a request for exemption. An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply. The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role. Official Title : Program Coordinator III Primary Location : United States-Massachusetts-Quincy - 100 Hancock Street Job : Administrative Services Agency : Exec Office Of Health and Human Services Schedule : Full-time Shift : Day Job Posting : Dec 20, 2025, 11:10:53 AM Number of Openings : 2 Salary : 70,737.16 - 103,443.08 Yearly If you have Diversity, Affirmative Action or Equal Employment Opportunity questions or need a Reasonable Accommodation, please contact Diversity Officer / ADA Coordinator : Diane Randolph-Jones - 8577570096 Bargaining Unit : 06-NAGE - Professional Admin. Confidential : No Potentially Eligible for a Hybrid Work Schedule : Yes