Senior Healthcare Claims Processor – Federal WTC Program

General Dynamics Information Technology, Inc.; United States; Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

Competitive pay

Comprehensive benefits

401K with company match

Paid time off

Full-flex work week

Job summary

General Dynamics Information Technology, Inc. seeks a Healthcare Claims Processor to review and adjudicate professional, facility, complex, and high-dollar medical claims in support of the World Trade Center Health Program.

You will ensure timely, compliant determinations, apply coding rules (ICD-10, CPT, HCPCS), and collaborate with cross-functional teams to resolve variances while protecting member privacy under HIPAA.

Qualifications

• 5+ years of hands-on experience processing medical professional and facility claims.
• Proficient in ICD-10, CPT, and HCPCS coding.
• Experience with modifiers, bill types, and adjudication guidelines.
• Knowledge of medical terminology and insurance operations.
• High attention to detail with accuracy in high-volume environments.
• Ability to apply program policies, payer rules, and federal regulations.
• Willingness to ongoing training on coding standards and system updates.
• Experience with claim denial resolution and appeals workflows.
• Strong analytical and customer-service mindset.

Responsibilities

• Evaluate, process, and adjudicate medical claims—including professional, facility, complex, and high‑dollar claims—in alignment with program rules, policies, and federal guidelines.
• Apply analytical and problem‑solving skills to interpret program policies, coding rules, and regulatory guidance during claim review.
• Ensure claims are processed within required timeframes and address discrepancies to maintain compliance with timeliness and quality standards.
• Resolve claim variances and collaborate with cross‑functional teams to identify root causes and implement corrective actions.
• Protect member information and uphold HIPAA and program‑specific confidentiality requirements.
• Monitor and report trends, recurring issues, or claim anomalies to support operational reporting and workflow improvements.
• Support internal and external audits by providing documentation, clarifying claim outcomes, and validating compliance with policy and regulatory requirements.
• Demonstrate flexibility in supporting operational ramp‑ups, backlogs, or shifting workload priorities.

Skills

Medical claims processing

ICD-10 CPT HCPCS coding

Regulatory compliance

Attention to detail

Analytical thinking

Customer service mindset

Job description

General Dynamics Information Technology, Inc. seeks a Healthcare Claims Processor to review and adjudicate professional, facility, complex, and high-dollar medical claims in support of the World Trade Center Health Program.

You will ensure timely, compliant determinations, apply coding rules (ICD-10, CPT, HCPCS), and collaborate with cross-functional teams to resolve variances while protecting member privacy under HIPAA.