Claims Processing Lead - WTCHP TPA
General Dynamics
Claims Processing Lead
GDIT is seeking a highly skilled Claims Processing Lead to oversee the adjudication and processing workflows for the World Trade Center (WTC) Health Program. This role is pivotal in ensuring that WTC responders and survivors receive timely and accurate medical benefits. You will lead a team of processors, serve as the primary subject matter expert for complex federal claim regulations, and ensure all activities meet the strict compliance standards of the WTC Health Program.
The World Trade Center Health Program is a limited federal health program administered by the National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention in the U.S. Department of Health and Human Services. 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.
Minimum Qualifications:
- Minimum of a Bachelor of Arts (BA) or Bachelor of Science (BS) degree.
- 5+ years of experience in healthcare claims processing, with at least 2 years in a lead, supervisory, or senior auditing capacity.
- Must have mastery of claims platforms experience (e.g., CareSuite, QNXT, Facets) and advanced Microsoft Excel skills.
- Must have a comprehensive understanding of CMS-1500 and UB-04 forms, ICD-10/CPT coding, and federal reimbursement methodologies.
- Must have experience managing a claims team.
- Exceptional written and verbal communication skills for presenting data and managing internal and external relationships.
- Ability to obtain and maintain a Public Trust clearance
Preferred Qualifications:
- Prior experience supporting the World Trade Center Health Program or other federal government health contracts.
- Professional certification such as CPC (Certified Professional Coder) or CHDA (Certified Health Data Analyst).
- Strong analytical mindset with the ability to translate complex clinical rules into technical system requirements
GDIT IS YOUR PLACE:
- 401K with company match
- Comprehensive health and wellness packages
- Internal mobility team dedicated to helping you own your career
- Professional scientific growth opportunities, including journal subscriptions, conference attendance, and supporting publication journey
- Cutting-edge technology you can learn from
- Rest and recharge with paid vacation and holidays
Vacancy posted 1 day ago
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