医疗理赔主管

Type of Requisition:
RegularClearance Level Must Currently Possess:
NoneClearance Level Must Be Able to Obtain:
NonePublic Trust/Other Required:
MBI (T2)Job Family:
Contact CenterJob Qualifications:
Skills:
Claims Adjudication, Claims Processing, Healthcare ClaimsCertifications:
NoneExperience:
3 + years of related experienceUS Citizenship Required:
NoJob Description:
The World Trade Center Health Program is a limited federal health program administered by the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC) in the U.S. Department of Health and Human Services (HHS). The Program provides no-cost medical monitoring and treatment for certified WTC-related health conditions to those directly affected by the 9/11 attacks in New York, the Pentagon, and in Shanksville, Pennsylvania
Own your opportunity to lead claims operations that directly support a federally funded healthcare mission. As a Healthcare Claims Supervisor at GDIT, you’ll turn operational expertise into mission impact while growing your leadership capabilities and strengthening claims processing performance across a high-volume TPA environment.
MEANINGFUL WORK AND PERSONAL IMPACT
As a Healthcare Claims Supervisor, the work you’ll do at GDIT will support the mission of a limited-benefit federal healthcare program. You will play a crucial role in ensuring medical claims are reviewed and adjudicated accurately, compliantly, and efficiently—enabling beneficiaries to receive timely and appropriate coverage determinations.

• Supervise day-to-day operations of a medical claims processing team responsible for reviewing, analyzing, and adjudicating professional, facility, and complex claim types.
• ● Oversee workload distribution, staffing coverage, productivity expectations, and performance monitoring to meet contractual timeliness and accuracy standards.
• ● Provide coaching, mentoring, and training on claims rules, system changes, Program policy updates, and adjudication procedures to strengthen team expertise.
• ● Conduct quality reviews, identify error trends, and implement process improvements to enhance accuracy, compliance, and operational efficiency.
• ● Serve as a subject matter resource for escalations, benefit interpretations, complex claims, and policy questions.
• ● Ensure proper claim documentation, consistent policy application, and audit-ready recordkeeping across all adjudication actions.
• ● Collaborate with Medical Policy, Utilization Management, Finance, Provider Services, and Compliance teams to resolve claim discrepancies, coding issues, or benefit concerns.
• ● Track metrics and prepare operational reports related to productivity, quality, timeliness, inventory aging, and issue trends.
• ● Support testing and validation of system updates, benefit modifications, policy changes, or new workflows.
• ● Contribute to hiring, onboarding, performance evaluations, and ongoing development of claims processing staff.
• ● Ensure compliance with HIPAA and program confidentiality requirements.
• ● Participate in operational redesign and continuous improvement initiatives to optimize claims processing outcomes.

WHAT YOU’LL NEED TO SUCCEED
Bring your expertise and leadership to GDIT. The Healthcare Claims Supervisor must have:

• 5+ years of experience in medical claims processing within a payer, TPA, or government healthcare environment
• ● 2+ years of lead, senior, or supervisory experience supporting claims operations
• ● Strong understanding of claims adjudication, reimbursement methodologies, and regulatory requirements
• ● Knowledge of professional and facility claim formats, modifiers, bill types, and industry-standard adjudication rules
• ● Proficiency with claims processing systems (Plexis is a plus)
• ● Strong analytical skills with the ability to interpret claims data, identify root causes, and resolve complex issues
• ● Excellent communication skills for coaching staff and collaborating across operational teams
• ● High attention to detail and commitment to accuracy and compliance
• ● Ability to work independently and lead a remote or distributed team effectively

GDIT IS YOUR PLACE
At GDIT, the mission is our purpose, and our people are at the center of everything we do.

• Growth: AI-powered career tool that identifies career steps and learning opportunities
• ● Support: An internal mobility team focused on helping you achieve your career goals
• ● Rewards: Comprehensive benefits and wellness packages, 401K with company match, competitive pay, and paid time off
• ● Flexibility: Full-flex work week to own your priorities at work and at home
• ● Community: Award-winning culture of innovation and a military-friendly workplace

#GDITFedHealthJobs

#WTCJobs
The likely salary range for this position is $59,500 - $80,500. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.Scheduled Weekly Hours:
40Travel Required:
NoneTelecommuting Options:
RemoteWork Location:
Any Location / RemoteAdditional Work Locations:
Total Rewards at GDIT:
Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee’s date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.
Our Identity Verification Process:
As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against identity fraud. You are expected to be on camera during virtual interviews. We reserve the right to take your picture to verify your identity and prevent fraud. By proceeding, you authorize the collection, processing, and use of your biometric data for identity verification and security purposes.About Our Work:
We are GDIT. A global technology and professional services company that delivers technology solutions and mission services to every major agency across the U.S. government, defense and intelligence community. Our 26,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50+ countries worldwide, offering leading mission-ready capabilities in AI, cloud, cyber and software development.Join our Talent Community to stay up to date on our career opportunities and events atgdit.com/tc.
Equal Opportunity Employer / Individuals with Disabilities / Protected VeteransOriginally posted on Himalayas