Hybrid Medicaid Claims Operations Leader

General Dynamics Information Technology, Inc.; Montgomery (AL); Hybrid; USD 111,000 - 150,000; Full time

Benefits offered by this job

401K with company match

Paid time off

Full-flex work week

Job summary

General Dynamics Information Technology, Inc. seeks a Claims Operations Manager to optimize Medicaid MES claims processing, including adjudication and resolution, while ensuring compliance with SLAs and regulations. Lead a team to deliver accurate, timely results and advise leadership on operational improvements.

Hybrid work arrangement in the Montgomery, AL area is expected; travel may be required. Strong leadership, process improvement, and MT/NCQA familiarity are highly valued for this role.

Qualifications

• Education: Bachelor's Degree in related technical, scientific, business, health or a related discipline
• Required Experience: 5+ years of related experience
• Required Skills and Abilities: Medicaid Operations Leadership Support, Project Management Skills, Provider Enrollment Management Skills and Experience, NCQA CVO knowledge and experience. 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).
• Preferred Qualifications: 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).

Responsibilities

• Manage day-to-day MES claims operations, ensuring timely and accurate processing, adjudication, and resolution of Medicaid claims according to guidelines and contractual SLAs.
• Act as a thought partner to the leadership team to provide support and counsel for operations management, communications, initiatives and projects.
• Be a self-starter with outstanding organization and communication skills in a fast-paced environment.
• Understand strategic financials regarding areas of oversight.
• Build strong partnerships with colleagues and balance diverse business solutions while leading professional working groups.
• Make critical decisions with limited guidance while ensuring visibility into those decisions.
• Oversee Provider Enrollment operations and optimize resources to facilitate SLA deliverables.
• Lead cross departmental deliverables for audits, business continuity, and program operations.
• Mentor operational managers on key processes and train teams.
• Coordinate NCQA CVO efforts and manage stakeholder relationships.

Skills

Claims Operations

Healthcare Claims Processing

Medicaid Claims

Medicaid Policy

People Management

Education

Bachelor's Degree in related fields

Job description

General Dynamics Information Technology, Inc. seeks a Claims Operations Manager to optimize Medicaid MES claims processing, including adjudication and resolution, while ensuring compliance with SLAs and regulations. Lead a team to deliver accurate, timely results and advise leadership on operational improvements.

Hybrid work arrangement in the Montgomery, AL area is expected; travel may be required. Strong leadership, process improvement, and MT/NCQA familiarity are highly valued for this role.