Healthcare Claims Processor
About The Position
The World Trade Center Health Program is a limited federal health program administered by the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC) in the U.S. Department of Health and Human Services (HHS). The Program provides no-cost medical monitoring and treatment for certified WTC-related health conditions to those directly affected by the 9/11 attacks in New York, the Pentagon, and in Shanksville, Pennsylvania. Own your opportunity to support medical claims operations that directly impact a federally funded healthcare program. As a Healthcare Claims Processor at GDIT, you’ll apply your claims expertise to ensure accurate, compliant, and timely adjudication while strengthening overall claims integrity and operational performance. MEANINGFUL WORK AND PERSONAL IMPACT As a Healthcare Claims Processor, the work you’ll do at GDIT will support the mission of the World Trade Center Health Program’s Third‑Party Administrator operations. You will play a critical role in accurately reviewing and adjudicating professional, facility, complex, and high‑dollar medical claims—ensuring beneficiaries receive fair, timely, and policy‑aligned claim determinations.
Requirements
- Minimum 5 years of hands‑on experience processing medical professional and facility claims, including complex and high‑dollar claims
- Working knowledge of ICD‑10, CPT, and HCPCS coding systems
- Demonstrated experience with modifiers, bill types, and standard adjudication guidelines
- Strong understanding of medical terminology, healthcare delivery, and insurance operations (workers’ compensation experience is a plus)
- High attention to detail with proven accuracy in high‑volume processing environments
- Ability to interpret and apply program policies, payer rules, and federal regulations
- Commitment to ongoing training and staying current on coding standards, regulatory changes, and system updates
- Experience with claim denial resolution and appeals workflows
- Strong analytical and customer‑service mindset with the ability to problem‑solve effectively
Nice To Haves
- workers’ compensation experience is a plus
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 proactively 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.
Benefits
- Comprehensive benefits and wellness packages
- 401K with company match
- competitive pay
- paid time off
- variety of medical plan options, some with Health Savings Accounts
- dental plan options
- a vision plan
- 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
- full flex work weeks where possible
- a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave
- 15 days of paid leave per calendar year to be used for vacations, personal business, and illness
- an additional 10 paid holidays per year
- Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
