Senior Healthcare Claims Adjudicator - Remote

General Dynamics Information Technology, Inc.; Virginia; Hybrid; USD 24,000 - 30,000; Full time

Benefits offered by this job

Medical plan options

401(k) plan

Paid time off

Flexible work weeks

Job summary

General Dynamics Information Technology, Inc. seeks a Healthcare Senior Claims Processor to support day-to-day medical claims operations within a Third-Party Administrator (TPA) environment serving a federally funded, limited-benefit program.

You will review, analyze, and adjudicate professional, facility, complex, and high-dollar claims in accordance with program guidelines, regulatory requirements, and internal quality standards.

Qualifications

• Minimum 5 years of hands-on experience processing medical professional and facility claims, including complex and high-dollar claims.
• Strong working knowledge of ICD-10, CPT, HCPCS, revenue codes, and modifiers.
• Understanding of the full claim lifecycle: intake, review, adjudication, reimbursement, adjustments, denials/rejections, and escalations.
• Demonstrated experience in interpreting and applying payer policies and federal regulations.
• Experience resolving claim denials, appeals, and complex adjudication questions.

Responsibilities

• Evaluate, process, and adjudicate professional, facility, complex, and high-dollar claims in alignment with program policies and federal guidelines.
• Interpret and apply reimbursement requirements, billing rules, modifiers, benefit limitations, and regulatory guidance.
• Resolve escalated claim issues, variances, exceptions, and discrepancies.
• Provide day-to-day technical expertise to claims processors on complex adjudication scenarios.
• Ensure accuracy, timeliness, and compliance with service-level requirements.
• Help define and maintain claims workflows, operating procedures, escalation paths, and quality controls.
• Translate claims policies and system rules into clear, repeatable processing instructions.

Skills

CPT Coding

Healthcare Claims

ICD-10

Revenue Codes

Modifiers

Tools

Claims processing systems

Microsoft Office

Job description

General Dynamics Information Technology, Inc. seeks a Healthcare Senior Claims Processor to support day-to-day medical claims operations within a Third-Party Administrator (TPA) environment serving a federally funded, limited-benefit program.

You will review, analyze, and adjudicate professional, facility, complex, and high-dollar claims in accordance with program guidelines, regulatory requirements, and internal quality standards.