Senior Healthcare Claims Processor

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $18 - $25 / hour

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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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

• Review, analyze, evaluate, process, and adjudicate professional, facility, complex, and high-dollar medical claims • Apply program guidelines, reimbursement requirements, billing rules, modifiers, benefit limitations, regulatory guidance, payer policies, and federal regulations • Resolve escalated claim issues, variances, exceptions, discrepancies, denials, appeals, and complex adjudication questions • Provide day-to-day technical guidance to claims processors on complex adjudication scenarios • Mentor and coach claims processors and peers • Ensure accuracy, timeliness, compliance, privacy, data security, and service-level adherence • Define and maintain claims workflows, operating procedures, escalation paths, and quality controls • Translate claims policies and system rules into repeatable processing instructions • Recommend operational improvements and assist with standard operating procedure updates • Support training programs and develop job aids, desk guides, examples, and knowledge-check materials • Identify knowledge gaps and recommend targeted training interventions • Participate in claims quality reviews, calibration sessions, audits, and root-cause analysis • Document claim decisions and support internal and external audit requests • Monitor emerging trends and propose changes to training, processes, or system rules

🎯 Requirements

• Minimum 5 years of hands-on experience processing medical professional and facility claims, including complex and high-dollar claims • Strong working knowledge of ICD-10, CPT, HCPCS, revenue codes, and modifiers • Understanding of the full claim lifecycle: intake, review, adjudication, reimbursement, adjustments, denials/rejections, and escalations • Demonstrated experience interpreting and applying payer policies and federal regulations • Experience resolving claim denials, appeals, and complex adjudication questions • High accuracy in high-volume environments • Strong analytical and problem-solving skills • Proficiency with Microsoft Office and claims processing systems • Ability to interpret and apply program policies, payer rules, and federal regulations • Commitment to ongoing training and staying current on industry standards, technology, and regulatory changes • Experience with claim denial resolution and appeals workflows • Customer-service mindset • MBI (T2) public trust/other required clearance

🏖️ Benefits

• Medical plan options, including plans with Health Savings Accounts • Dental plan options • Vision plan • 401(k) plan with pre-tax and post-tax contributions and company match • Full flex work weeks where possible • Paid vacation, sick, and personal time • Paid holidays • Paid parental, military, bereavement, and jury duty leave • Typically 15 days of paid leave per calendar year • Typically 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 • Remote work • Identity verification and security process using advanced biometrics and artificial intelligence