Medicaid Claims Operations Manager

Public Trust: Other

Requisition Type: Pipeline

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

At General Dynamics Information Technology (GDIT), we support state agencies in streamlining Medicaid Enterprise Systems (MES) by delivering operational efficiency and excellence.

We are seeking a Claims Operations Manager to oversee and optimize the day-to-day MES claims processing operations under the Fiscal Agent Operations function. This role involves managing the processing, adjudication, and resolution of healthcare claims for Medicaid beneficiaries while ensuring operational compliance and consistent service delivery.

As the Claims Operations Manager, you will lead a team responsible for ensuring that Medicaid claims processing operations meet performance standards, comply with state and federal regulations, and deliver a high degree of accuracy and timeliness.

Responsibilities

• Manage and oversee day-to-day MES claims operations, including staff and other supervisors, to ensure timely and accurate processing, adjudication, and resolution of Medicaid claims according to guidelines and contractual Service Level Agreements (SLAs).
• Builds strong partnerships with colleagues, desires to be flexible and think proactively, strategically, and analytically about diverse business solutions and leading professional working groups.
• Manages claims operations for the program, including optimizing resources to facilitate SLA deliverables and maximize efficient operations. Manages change management efforts and reporting to optimize SLAs and ensure optimization of resources.
• Will be the primary point of contact for the state customers and responsible for managing all claims processing operations, including but not limited to:  Claims Resolution, Drug Rebate, Medical Policy, Financial Transactions, and Data Entry
• Lead cross departmental operational efforts for internal and external quality assessments, audits and surveys.
• Drives  communication initiatives to both internal and external stakeholders, including community engagement efforts and efforts to facilitate engagement.
• Responsible for ensuring operations staff follow defined processes and procedures
• Analysis and report on performance of operations activities
• Primary point of contact for CMS Regulation and State Plan Policies

Required Skills and Qualifications

• Education: Bachelor's Degree in related technical, scientific, business, health or a related discipline (or equivalent work experience)
• Required Experience: Eight (8) years of experience managing Medicaid or Major Health Care Payer Claims processing
• Required Skills and Abilities:
  • Medicaid Operations Leadership Support
  • Project an people management skills. 
  • Knowledge and experience related to state Medicaid systems support and operations/administration, especially related to claims processing.
  • Demonstrated ability to communicate issues, impacts, and corrective actions
• Preferred Skills:
  • SharePoint, Excel, PMO, PowerPoint
  • Strong knowledge of Medicaid Fee-for-Service (FFS), and Managed Care claims processes.
  • Experience with healthcare claims software platforms and operational workflows.
  • Experience in claims repricing and interaction with national coding standards (e.g., CPT, ICD-10, HCPCS).
  • Familiarity with Program Integrity (PI) workflows, fraud/waste/abuse detection, and encounter data validation.
  • Proficiency with claims adjudication systems, reporting tools, and analytics platforms like Tableau or Power BI.
  • Familiarity with Medicaid Information Technology Architecture (MITA) and CMS certification processes.
  • Highly desirable certifications such as Certified Medical Reimbursement Specialist (CMRS) or lean process improvement certifications (e.g., Six Sigma).

Additional Information:

Location: Montgomery, AL.

Security: A fingerprint based background check will be required.

Timeline: This is a contingent job posting. Work is not expected to begin until June 2027 or later.

Work visa sponsorship will not be provided for this position.

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

● 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

OWN YOUR OPPORTUNITY

Explore an enterprise IT career at GDIT and you’ll find endless opportunities to grow alongside colleagues who share your desire to drive operations forward.

Work Requirements

Years of Experience

8 + years of related experience

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

Certification

Travel Required

Less than 10%