Healthcare Senior Claims Processor

About this role

Type of Requisition:
RegularClearance Level Must Currently Possess:
NoneClearance Level Must Be Able to Obtain:
NonePublic Trust/Other Required:
MBI (T2)Job Family:
SCAJob Qualifications:
Skills:
CPT Coding, Healthcare Claims, ICD-10 Procedure Coding SystemCertifications:
NoneExperience:
5 + years of related experienceUS Citizenship Required:
NoJob Description:
At GDIT, people are our differentiator. We are seeking Healthcare Senior Claims Processors to support day-to-day medical claims operations within a Third-Party Administrator (TPA) environment serving the federally funded, limited-benefit World Trade Center Health Program.

In this role, you will review, analyze, and adjudicate professional, facility, complex, and high-dollar claims in accordance with program guidelines, regulatory requirements, and internal quality standards. You will apply strong critical-thinking skills, provide advanced technical guidance to claims staff, mentor processors, maintain strict confidentiality, mentor peers, participate in audits, and contribute to continuous improvement activities that strengthen overall claims operations performance.

The Senior Claims Processor will also ensure consistent interpretation of claim policies; and support operational readiness, training, and workflow optimization.

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.

• Recommend operational improvements to increase efficiency, accuracy, and consistency.

• Assist with updates to standard operating procedures when requirements change.

• Support training programs for new and existing claims processors.

• Develop or refine job aids, desk guides, examples, and knowledge-check materials.

• Provide coaching on claims quality, system navigation, and procedural accuracy.

• Identify knowledge gaps and recommend targeted training interventions.

• Participate in claims quality reviews, calibration sessions, and root-cause analysis.

• Document claim decisions clearly and support internal and external audit requests.

• Monitor emerging trends and propose changes to training, processes, or system rules.

• Promote adherence to privacy, data security, federal requirements, and organizational policies.

Requirements:

• 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’s 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.

• High accuracy in high-volume environments with strong analytical and problem-solving skills.

• Proficiency with Microsoft Office and claims processing systems.

• Ability to interpret and apply program policies, payer rules, and federal regulations.

• Commitment to ongoing training and staying current on industry standards, technology, and regulatory changes.

• Experience with claim denial resolution and appeals workflows.

• Customer-service mindset with strong analytical and problem-solving skills.

The likely hourly rate for this position is between $18.70 - $25.30. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.Scheduled Weekly Hours:
40Travel Required:
NoneTelecommuting Options:
RemoteWork Location:
Any Location / RemoteAdditional Work Locations:
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. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee’s date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. 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.Our Identify Verification Process:
As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against…