Remote Senior Healthcare Claims Systems Analyst

Gdh Consulting, Inc.; Washington (District of Columbia); Remote; USD 132,000 - 138,000; Full time

Benefits offered by this job

Health benefits options

Wellbeats membership

Gym membership discount

401(k) plan

Employee referral program

Job summary

GDH is seeking an experienced Subject Matter Expert to lead expert guidance on healthcare claims administration, payment operations, and regulated environments. The role provides strategic insight to improve program performance, compliance, and contractor interactions.

You will advise on claims processing, provider enrollment, appeals, and coverage determinations while partnering with project teams to evaluate operations and identify improvement opportunities in a remote setting.

Qualifications

• Extensive knowledge of healthcare claims administration and payment operations.
• Experience in complex regulated healthcare environments and workflows.
• Ability to communicate complex program information to diverse stakeholders.

Responsibilities

• Serve as SME on large-scale healthcare claims administration and payment operations.
• Advise project teams on claims processing, provider enrollment, appeals, and coverage determinations.
• Analyze volumes and provider populations to support program evaluation and decision-making.
• Guide contractor relationships and workflows across complex healthcare programs.
• Support contracting and compliance by interpreting procurement requirements and regulations.
• Collaborate with managers, analysts, and technical leads to identify improvements.
• Contribute SME expertise to solution development, proposals, and technical documentation.
• Provide guidance on data flows, interoperability, and claims processing impact.

Skills

Healthcare claims

Payment operations

Regulated environments

Education

Relevant education or certifications

Job description

GDH is seeking an experienced Subject Matter Expert to lead expert guidance on healthcare claims administration, payment operations, and regulated environments. The role provides strategic insight to improve program performance, compliance, and contractor interactions.

You will advise on claims processing, provider enrollment, appeals, and coverage determinations while partnering with project teams to evaluate operations and identify improvement opportunities in a remote setting.