Healthcare Claims Supervisor
About The Position
Own your opportunity to lead claims operations that directly support a federally funded healthcare mission. As a Healthcare Claims Supervisor at GDIT, you’ll turn operational expertise into mission impact while growing your leadership capabilities and strengthening claims processing performance across a high-volume TPA environment. As a Healthcare Claims Supervisor, the work you’ll do at GDIT will support the mission of a limited-benefit federal healthcare program. You will play a crucial role in ensuring medical claims are reviewed and adjudicated accurately, compliantly, and efficiently—enabling beneficiaries to receive timely and appropriate coverage determinations.
Requirements
- 5+ years of experience in medical claims processing within a payer, TPA, or government healthcare environment
- 2+ years of lead, senior, or supervisory experience supporting claims operations
- Strong understanding of claims adjudication, reimbursement methodologies, and regulatory requirements
- Knowledge of professional and facility claim formats, modifiers, bill types, and industry-standard adjudication rules
- Proficiency with claims processing systems (Plexis is a plus)
- Strong analytical skills with the ability to interpret claims data, identify root causes, and resolve complex issues
- Excellent communication skills for coaching staff and collaborating across operational teams
- High attention to detail and commitment to accuracy and compliance
- Ability to work independently and lead a remote or distributed team effectively
Nice To Haves
- Plexis experience
Responsibilities
- Supervise day-to-day operations of a medical claims processing team responsible for reviewing, analyzing, and adjudicating professional, facility, and complex claim types.
- Oversee workload distribution, staffing coverage, productivity expectations, and performance monitoring to meet contractual timeliness and accuracy standards.
- Provide coaching, mentoring, and training on claims rules, system changes, Program policy updates, and adjudication procedures to strengthen team expertise.
- Conduct quality reviews, identify error trends, and implement process improvements to enhance accuracy, compliance, and operational efficiency.
- Serve as a subject matter resource for escalations, benefit interpretations, complex claims, and policy questions.
- Ensure proper claim documentation, consistent policy application, and audit-ready recordkeeping across all adjudication actions.
- Collaborate with Medical Policy, Utilization Management, Finance, Provider Services, and Compliance teams to resolve claim discrepancies, coding issues, or benefit concerns.
- Track metrics and prepare operational reports related to productivity, quality, timeliness, inventory aging, and issue trends.
- Support testing and validation of system updates, benefit modifications, policy changes, or new workflows.
- Contribute to hiring, onboarding, performance evaluations, and ongoing development of claims processing staff.
- Ensure compliance with HIPAA and program confidentiality requirements.
- Participate in operational redesign and continuous improvement initiatives to optimize claims processing outcomes.
Benefits
- Comprehensive benefits and wellness packages
- 401K with company match
- Competitive pay
- Paid time off
- Full flex work weeks
- 15 days of paid leave per calendar year
- 10 paid holidays per year
- Paid Family Leave program (up to 160 hours)
- Short and long-term disability benefits
- Life insurance
- Accidental death and dismemberment insurance
- Personal accident insurance
- Critical illness insurance
- Business travel and accident insurance
- Variety of medical plan options
- Health Savings Accounts
- Dental plan options
- Vision plan
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
No Education Listed
