Nurse Healthcare Claims Examiner (RN Required)

Public Trust: None

Requisition Type: Regular

Your Impact

Own your opportunity to work alongside state and local government. Make an impact by delivering solutions and services that secure our communities and make a difference in people’s lives every day.

Job Description

HEALTHCARE CLAIMS EXAMINER

Solve real-world challenges that impact the frontlines of public health, life science, and clinical research initiatives as a Healthcare Claims Examiner at GDIT. You’ll support the mission and grow with it, building a meaningful career in health. The candidate for this position will be required to perform prior approval reviews under the private duty nursing and the durable medical equipment prior approval review programs. The Division of Health Benefits (DHB) Clinical Coverage Policy is expected to be utilized and referenced in adjudicating the prior approval requests. The candidate will be expected to meet GDIT's service level agreement (SLA) with DHB in each of their assigned areas of review.The average quantity SLA goal is 20-30 reviews each day. The candidate will be expected to meet the quality review expectations on at least 95% of cases reviewed monthly. Clear written denial summaries of resident reviews and additional information request is required. Strong organizational, analytical, decision making and leaderships skills are desired.

MEANINGFUL WORK AND PERSONAL IMPACT
As a Healthcare Claims Examiner, the work you’ll do at GDIT will be impactful to the mission of our customer. You will play a crucial role in determining the level of services needed for prior approval requests.

● Collaborate with other team members.
● Drive corporate goals.
● Utilize DHB policies and NCTracks system.

WHAT YOU’LL NEED TO SUCCEED
Bring your nursing expertise and drive for innovation to GDIT. The Healthcare Claims Examiner must have:
● Education: Bachelor of Arts/Bachelor of Science or Associate Degree in Nursing
● Experience: 2+ years of related experience
● Technical skills: computer and communication skills
● Security clearance level: None.
● US citizenship required
● Role requirements: RN License

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, and competitive pay and paid time off
● Community: Award-winning culture of innovation and a military-friendly workplace

OWN YOUR OPPORTUNITY
Explore a career in health at GDIT and you’ll find endless opportunities to grow alongside colleagues who share your sense of purpose for making a difference.

Work Requirements

Years of Experience

2 + years of related experience

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

Certification

Travel Required

None