Medicaid Claims Operations Leader

General Dynamics Information Technology; Montgomery (AL); Hybrid; USD 105,000 - 145,000; Full time

Job summary

General Dynamics Information Technology (GDIT) seeks a Claims Operations Manager to oversee Medicaid Enterprise Systems (MES) claims processing operations within the Fiscal Agent Operations function. The role focuses on processing, adjudication, and resolution of Medicaid claims with strict adherence to SLAs and regulations.

You will lead a team to ensure accuracy, timeliness, and compliance while collaborating with leadership on strategic initiatives and performance improvements.

Qualifications

• Bachelor’s degree in a related technical, scientific, business, health or related discipline.
• 5+ years of related experience.
• Experience leading Medicaid operations and provider enrollment.
• Strong communication, problem-solving and corrective-action abilities.

Responsibilities

• Oversee day-to-day MES claims operations ensuring timely and accurate processing, adjudication, and resolution of Medicaid claims.
• Provide leadership support and counsel to operations management and cross-functional teams.
• Lead change management and reporting to optimize SLAs and resource use.
• Manage Provider Enrollment operations and NCQA CVO related activities.
• Coordinate internal/external audits, business continuity and quality assessments.

Skills

Medicaid Operations Leadership

Project Management

Provider Enrollment Management

NCQA CVO knowledge

Communication skills

SharePoint

Excel

PowerPoint

PMO

Tableau/Power BI

CMRS (Six Sigma)

Education

Bachelor's Degree in related discipline

Tools

Tableau

Power BI

Job description

General Dynamics Information Technology (GDIT) seeks a Claims Operations Manager to oversee Medicaid Enterprise Systems (MES) claims processing operations within the Fiscal Agent Operations function. The role focuses on processing, adjudication, and resolution of Medicaid claims with strict adherence to SLAs and regulations.

You will lead a team to ensure accuracy, timeliness, and compliance while collaborating with leadership on strategic initiatives and performance improvements.