Medicaid Claims Operations Manager

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

Benefits offered by this job

Health plan options

401K with company match

Paid time off

Full flex work weeks

Job summary

General Dynamics Information Technology (GDIT) is seeking a Claims Operations Manager to lead the day-to-day Medicaid Enterprise System claims processing under the Fiscal Agent Operations function in Montgomery, AL. You will supervise staff, ensure SLA adherence, and optimize processing, adjudication, and resolution of Medicaid claims for beneficiaries.

The role requires a Bachelor's degree and 8 years of Medicaid or health payer claims experience, with strong leadership, stakeholder engagement,

Qualifications

• Bachelor's Degree in related technical, scientific, business, health or related discipline (or equivalent work experience).
• Eight (8) years of experience managing Medicaid or Major Health Care Payer Claims processing.
• Medicaid operations leadership and staff management abilities.
• Strong communication of issues, impacts, and corrective actions.

Responsibilities

• Manage day-to-day MES claims operations with staff and supervisors to ensure timely, accurate processing and adjudication of Medicaid claims.
• Lead cross-departmental efforts, optimize resources, and ensure SLA delivery.
• Serve as primary CMS/state customer contact and oversee all claims processing, including resolution, drug rebate, medical policy, and data entry.
• Drive change management and reporting to optimize SLAs and resource usage.
• Communicate with internal/external stakeholders and support audits and quality assessments.

Skills

Medicaid operations leadership

Staff leadership

Stakeholder engagement

Communication

Education

Bachelor's degree in related field

Tools

SharePoint

Excel

PMO

PowerPoint

Job description

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.

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

• 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.

The likely salary range for this position is $111,155 - $150,384.

Scheduled Weekly Hours: 40 Travel Required: Less than 10% Telecommuting Options: Hybrid Work Location: USA AL Montgomery

Total Rewards at GDIT

Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.

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