Healthcare Claims Processor

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $17 - $19 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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General Dynamics Information Technology

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1954

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

General Dynamics Information Technology is a company at the forefront of technological innovation, offering a wide range of services including consulting, digital modernization, and application services. The company is heavily involved in implementing solutions related to artificial intelligence, cloud computing, cybersecurity, high-performance computing, and quantum technologies. GDIT is committed to supporting government and defense sectors, providing mission-critical services such as logistics and supply chain management, intelligence, and homeland security. The company also focuses on diverse and inclusive hiring practices and actively promotes employee well-being. Through its digital accelerator solutions and pioneering use of emerging technologies, GDIT aims to propel agencies' missions forward and address complex technological challenges.

📋 Description

• Evaluate, process, and adjudicate professional, facility, complex, and high-dollar medical claims • Apply analytical and problem-solving skills to interpret program policies, coding rules, and regulatory guidance • Process claims within required timeframes and address discrepancies to maintain compliance with timeliness and quality standards • Resolve claim variances and collaborate with cross-functional teams to identify root causes and implement corrective actions • Protect member information and uphold HIPAA and program-specific confidentiality requirements • Monitor and report trends, recurring issues, and claim anomalies to support operational reporting and workflow improvements • Support internal and external audits by providing documentation, clarifying claim outcomes, and validating compliance • Support operational ramp-ups, backlogs, and shifting workload priorities • Support the World Trade Center Health Program’s Third-Party Administrator operations at GDIT

🎯 Requirements

• Minimum 5 years of hands-on experience processing medical professional and facility claims, including complex and high-dollar claims • Working knowledge of ICD-10, CPT, and HCPCS coding systems • Demonstrated experience with modifiers, bill types, and standard adjudication guidelines • Strong understanding of medical terminology, healthcare delivery, and insurance operations • Workers’ compensation experience is a plus • High attention to detail with proven accuracy in high-volume processing environments • Ability to interpret and apply program policies, payer rules, and federal regulations • Commitment to ongoing training and staying current on coding standards, regulatory changes, and system updates • Experience with claim denial resolution and appeals workflows • Strong analytical and customer-service mindset with effective problem-solving ability • MBI (T2) public trust/other required • US citizenship is not required

🏖️ Benefits

• Comprehensive medical plan options, some with Health Savings Accounts • Dental plan options • Vision plan options • 401(k) plan with ability to contribute pre-tax and post-tax dollars and receive a company match • Full-flex work weeks where possible • Paid time off plans including vacation, sick, personal time, holidays, paid parental, military, bereavement, and jury duty leave • Typically 15 days of paid leave per calendar year • 10 paid holidays per year • Up to 160 hours of paid family leave in a rolling 12-month period for eligible employees • Short- and long-term disability benefits • Life insurance • Accidental death and dismemberment insurance • Personal accident insurance • Critical illness insurance • Business travel and accident insurance • AI-powered career tool identifying career steps and learning opportunities • Internal mobility team supporting career goals • Wellness packages • Competitive pay • Award-winning culture of innovation • Military-friendly workplace