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 SUCCEED
Minimum 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 purp