Medicaid Claims Operations Manager
About The Position
General Dynamics Information Technology (GDIT) is seeking a Claims Operations Manager to oversee and optimize day-to-day Medicaid Enterprise Systems (MES) claims processing under the Fiscal Agent Operations function. The manager leads staff and supervisors responsible for processing, adjudicating, and resolving Medicaid beneficiary claims, ensuring accuracy, timeliness, operational compliance, and adherence to performance standards and contractual Service Level Agreements (SLAs). The role manages resources, change initiatives, reporting, and operational performance to support efficient delivery of claims services. It serves as the primary point of contact for state customers and for CMS regulations and State Plan policies, and oversees areas including claims resolution, drug rebate, medical policy, financial transactions, and data entry. The manager also leads cross-departmental quality assessments, audits, surveys, and stakeholder communications. The position is based in Montgomery, Alabama, with hybrid telecommuting options. It is a contingent posting; work is not expected to begin until June 2027 or later. A fingerprint-based background check is required. Work visa sponsorship will not be provided. The scheduled work week is 40 hours, and travel is less than 10%.
Requirements
- Bachelor’s degree in a related technical, scientific, business, health, or related discipline, or equivalent work experience.
- Eight years of experience managing Medicaid or major healthcare payer claims processing.
- Medicaid operations leadership support skills.
- Project and people management skills.
- Knowledge and experience supporting and operating or administering state Medicaid systems, especially claims processing.
- Ability to communicate issues, impacts, and corrective actions.
- No security clearance is required; the posting states that a fingerprint-based background check will be required.
Nice To Haves
- Experience with SharePoint, Excel, PMO, and PowerPoint.
- Strong knowledge of Medicaid Fee-for-Service (FFS) and Managed Care claims processes.
- Experience with healthcare claims software platforms and operational workflows.
- Experience in claims repricing and interaction with national coding standards such as CPT, ICD-10, and HCPCS.
- Familiarity with Program Integrity workflows, fraud, waste, and abuse detection, and encounter data validation.
- Proficiency with claims adjudication systems, reporting tools, and analytics platforms such as Tableau or Power BI.
- Familiarity with Medicaid Information Technology Architecture (MITA) and CMS certification processes.
- Certified Medical Reimbursement Specialist (CMRS) or lean process improvement certifications such as Six Sigma are highly desirable.
Responsibilities
- Manage day-to-day MES claims operations, including staff and supervisors, to ensure timely and accurate processing, adjudication, and resolution of Medicaid claims in accordance with guidelines and contractual SLAs.
- Build partnerships with colleagues and contribute flexible, proactive, strategic, and analytical thinking to business solutions and professional working groups.
- Manage program claims operations and optimize resources to meet SLA deliverables and improve operational efficiency.
- Manage change efforts and reporting to optimize SLAs and resource utilization.
- Serve as the primary point of contact for state customers and manage claims operations, including claims resolution, drug rebate, medical policy, financial transactions, and data entry.
- Lead cross-departmental operational efforts for internal and external quality assessments, audits, and surveys.
- Drive communications with internal and external stakeholders, including community engagement efforts.
- Ensure operations staff follow defined processes and procedures.
- Analyze and report on operational performance.
- Serve as the primary point of contact for CMS regulations and State Plan policies.
Benefits
- Comprehensive benefits and wellness packages.
- 401(k) plan with company match.
- Competitive pay and paid time off.
- Medical plan options, including some with Health Savings Accounts.
- Dental plan options.
- Vision plan.
- Full-flex work weeks where possible.
- Vacation, sick, and personal time off, as well as holidays and paid parental, military, bereavement, and jury duty leave.
- 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.
- Growth and learning opportunities through an AI-powered career tool.
- Internal mobility support for career goals.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
