Medicaid Claims Operations Manager

General Dynamics Information Technology•Montgomery, AL

4d•Hybrid

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 Fiscal Agent Operations. The role manages Medicaid healthcare claims processing, adjudication, and resolution, ensuring compliance with state and federal regulations and consistent service delivery. The manager leads staff and supervisors to meet performance standards and deliver accurate, timely claims operations in accordance with guidelines and contractual Service Level Agreements (SLAs). The position is the primary contact for state customers and oversees claims-related functions including claims resolution, drug rebate, medical policy, financial transactions, and data entry. It also leads cross-departmental quality assessments, audits, and surveys; manages operational change and reporting; and communicates with internal and external stakeholders. The position is located in Montgomery, Alabama, and is listed as hybrid. This is a contingent posting, with work not expected to begin until June 2027 or later. The role is scheduled for 40 hours per week and requires less than 10% travel. A fingerprint-based background check is required; visa sponsorship is not available.

Requirements

Bachelor's degree in a related technical, scientific, business, health, or related discipline, or equivalent work experience.
Eight or more years of experience managing Medicaid or major healthcare payer claims processing.
Experience and skills in Medicaid operations leadership, support, project management, and people management.
Knowledge and experience supporting and administering state Medicaid systems, particularly claims processing.
Demonstrated ability to communicate issues, impacts, and corrective actions.
U.S. citizenship is not required.
Must complete a fingerprint-based background check.
Work visa sponsorship is not provided.

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 certification, such as Six Sigma.

Responsibilities

Manage day-to-day MES claims operations, including staff and other supervisors, to ensure timely and accurate Medicaid claims processing, adjudication, and resolution according to guidelines and contractual SLAs.
Build partnerships with colleagues and think proactively, strategically, and analytically about business solutions and professional working groups.
Manage program claims operations and optimize resources to meet SLA deliverables and operate efficiently.
Manage change efforts and reporting to optimize SLAs and resource use.
Serve as the primary point of contact for state customers and manage claims functions 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 the performance of operations activities.
Serve as the primary point of contact for CMS regulations and State Plan policies.