Description
At General Dynamics Information Technology (GDIT), we support state agencies in streamlining Medicaid Enterprise Systems (MES) by delivering operational efficiency and excellence.
We are seeking a Claims Operations Manager to oversee and optimize the day-to-day MES claims processing operations under the Fiscal Agent Operations function. This role involves managing the processing, adjudication, and resolution of healthcare claims for Medicaid beneficiaries while ensuring operational compliance and consistent service delivery.
As the Claims Operations Manager, you will lead a team responsible for ensuring that Medicaid claims processing operations meet performance standards, comply with state and federal regulations, and deliver a high degree of accuracy and timeliness.
Responsibilities
- Manage and oversee day-to-day MES claims operations, including staff and other supervisors, to ensure timely and accurate processing, adjudication, and resolution of Medicaid claims according to guidelines and contractual Service Level Agreements (SLAs).
- Build strong partnerships with colleagues, desires to be flexible and think proactively, strategically, and analytically about diverse business solutions and leading professional working groups.
- Manage claims operations for the program, including optimizing resources to facilitate SLA deliverables and maximize efficient operations.
- Will be the primary point of contact for the state customers and responsible for managing all claims processing operations, including but not limited to: 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 communication initiatives to both internal and external stakeholders, including community engagement efforts and efforts to facilitate engagement.
- Responsible for ensuring operations staff follow defined processes and procedures.
- Analysis and report on performance of operations activities.
- Primary point of contact for CMS Regulation and State Plan Policies.
Required Skills and Qualifications
- Education: Bachelor's Degree in related technical, scientific, business, health, or a related discipline (or equivalent work experience).
- Required Experience: Eight (8) years of experience managing Medicaid or Major Health Care Payer Claims processing.
- Required Skills and Abilities:
- Medicaid Operations Leadership Support
- Project and people management skills.
- Knowledge and experience related to state Medicaid systems support and operations/administration, especially related to claims processing.
- Demonstrated ability to communicate issues, impacts, and corrective actions.
Benefits
- Comprehensive benefits and wellness packages
- 401K with company match
- Competitive pay and paid time off
- Full-flex work week to own your priorities at work and at home
- Award-winning culture of innovation and a military-friendly workplace