Claims Processing Lead – WTCHP TPA

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Public Trust/Other Required:

MBI (T2)

Job Family:

Ancillary Health

Job Qualifications:

Skills:

CMS 1500 Claim Forms, Communication, Healthcare Claims Processing, Health Care Systems, ICD-10 Procedure Coding System

Certifications:

None

Experience:

5 + years of related experience

US Citizenship Required:

No

Job Description:

GDIT is seeking a highly skilled Claims Processing Lead to oversee the adjudication and processing workflows for the World Trade Center (WTC) Health Program. This role is pivotal in ensuring that WTC responders and survivors receive timely and accurate medical benefits. You will lead a team of processors, serve as the primary subject matter expert for complex federal claim regulations, and ensure all activities meet the strict compliance standards of the WTC Health Program.The World Trade Center Health Program is a limited federal health program administered by the National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention in the U.S. Department of Health and Human Services. 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.  HOW YOU WILL MAKE AN IMPACT

• Supervise a team of claims processors, providing daily technical guidance, performance feedback, and training on WTC-specific adjudication rules.
• Act as the final point of escalation for complex or high-dollar claims requiring manual review and clinical alignment with WTC-covered conditions.
• Implement and monitor rigorous Quality Assurance (QA) protocols to ensure 99%+ accuracy in claim payments and adherence to HIPAA and federal regulations.
• Identify bottlenecks in the claims lifecycle and collaborate with the IT and Codebook teams to automate manual processes and improve "clean claim" rates.
• Generate and present weekly production metrics to leadership, tracking turn-around times (TAT), error rates, and inventory levels.
• Coordinate with medical providers and federal program representatives to resolve billing disputes and clarify policy interpretations.

WHAT YOU’LL NEED TO SUCCEEDMinimum Qualifications

• Minimum of a Bachelor of Arts (BA) or Bachelor of Science (BS) degree.
• 5+ years of experience in healthcare claims processing, with at least 2 years in a lead, supervisory, or senior auditing capacity.
• Must have mastery of claims platforms experience (e.g., CareSuite, QNXT, Facets) and advanced Microsoft Excel skills.
• Must have a comprehensive understanding of CMS-1500 and UB-04 forms, ICD-10/CPT coding, and federal reimbursement methodologies.
• Must have experience managing a claims team.
• Exceptional written and verbal communication skills for presenting data and managing internal and external relationships.
• Ability to obtain and maintain a Public Trust clearance

Preferred Qualifications:

• Prior experience supporting the World Trade Center Health Program or other federal government health contracts.
• Professional certification such as CPC (Certified Professional Coder) or CHDA (Certified Health Data Analyst).
• Strong analytical mindset with the ability to translate complex clinical rules into technical system requirements

GDIT IS YOUR PLACE:

• 401K with company match
• Comprehensive health and wellness packages
• Internal mobility team dedicated to helping you own your career
• Professional scientific growth opportunities, including journal subscriptions, conference attendance, and supporting publication journey
• Cutting-edge technology you can learn from
• Rest and recharge with paid vacation and holidays

OWN YOUR OPPORTUNITY:
Explore a career in health at GDIT and you’ll find endless opportunities to grow alongside colleagues who share your sense of purpose for making a difference.#GDITFedHealth#GDITWTCJobs

The likely salary range for this position is $97,968 - $89,988. 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:

40

Travel Required:

10-25%

Telecommuting Options:

Remote

Work Location:

Any Location / Remote

Additional 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 Identity 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 identity fraud. You are expected to be on camera during virtual interviews. We reserve the right to take your picture to verify your identity and prevent fraud. By proceeding, you authorize the collection, processing, and use of your biometric data for identity verification and security purposes.

About Our Work:

We are GDIT. A global technology and professional services company that delivers technology solutions and mission services to every major agency across the U.S. government, defense and intelligence community. Our 26,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50+ countries worldwide, offering leading mission-ready capabilities in AI, cloud, cyber and software development.

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Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans