[Hiring] Healthcare Senior Claims Processor @General Dynamics Information Technology

Role Description

At GDIT, people are our differentiator. We are seeking Healthcare Senior Claims Processors to support day-to-day medical claims operations within a Third-Party Administrator (TPA) environment serving the federally funded, limited-benefit World Trade Center Health Program.

In this role, you will:

• Review, analyze, and adjudicate professional, facility, complex, and high-dollar claims in accordance with program guidelines, regulatory requirements, and internal quality standards.
• Apply strong critical-thinking skills, provide advanced technical guidance to claims staff, mentor processors, maintain strict confidentiality, participate in audits, and contribute to continuous improvement activities.
• Ensure consistent interpretation of claim policies; support operational readiness, training, and workflow optimization.

Qualifications

• 5+ years of related experience
• Skills: CPT Coding, Healthcare Claims, ICD-10 Procedure Coding System
• Certifications: None
• US Citizenship Required: No

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’s lifecycle: intake, review, adjudication, reimbursement, adjustments, denials/rejections, and escalations.
• Demonstrated experience in interpreting and applying payer policies and federal regulations.
• Experience resolving claim denials, appeals, and complex adjudication questions.
• High accuracy in high-volume environments with 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 with strong analytical and problem-solving skills.

Benefits

• Variety of medical plan options, some with Health Savings Accounts
• Dental plan options
• Vision plan
• 401(k) plan with company match
• Full flex work weeks where possible
• Variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement, and jury duty leave
• 15 days of paid leave per calendar year for vacations, personal business, and illness
• 10 paid holidays per year
• Paid Family Leave program providing up to 160 hours of paid leave in a rolling 12 month period for eligible employees
• Short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness, and business travel and accident insurance