Healthcare Claims Processor [Remote]

Public Trust: MBI (T2)

Requisition Type: Regular

Your Impact

Own your opportunity to be on the frontlines of health innovation. Deliver for America’s health agency missions and enhance lives for hundreds of millions every day.

Job 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 support medical claims operations that directly impact a federally funded healthcare program. As a Healthcare Claims Processor at GDIT, you’ll apply your claims expertise to ensure accurate, compliant, and timely adjudication while strengthening overall claims integrity and operational performance.

MEANINGFUL WORK AND PERSONAL IMPACT
As a Healthcare Claims Processor, the work you’ll do at GDIT will support the mission of the World Trade Center Health Program’s Third‑Party Administrator operations. You will play a critical role in accurately reviewing and adjudicating professional, facility, complex, and high‑dollar medical claims—ensuring beneficiaries receive fair, timely, and policy‑aligned claim determinations.

● Evaluate, process, and adjudicate medical claims—including professional, facility, complex, and high‑dollar claims—in alignment with program rules, policies, and federal guidelines.
● Apply analytical and problem‑solving skills to interpret program policies, coding rules, and regulatory guidance during claim review.
● Ensure claims are processed within required timeframes and proactively 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, or claim anomalies to support operational reporting and workflow improvements.
● Support internal and external audits by providing documentation, clarifying claim outcomes, and validating compliance with policy and regulatory requirements.
● Demonstrate flexibility in supporting operational ramp‑ups, backlogs, or shifting workload priorities.

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

● 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 the ability to problem‑solve 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

Work Requirements

Years of Experience

5 + years of related experience

* may vary based on technical training, certification(s), or degree

Certification

Travel Required

None