Healthcare Claims Examiner

General Dynamics Information Technology

. Evaluate the appropriateness of beneficiaries’ admission to nursing facilities .

Posted 9/18/2026full-timeRaleigh • North Carolina • United StatesJuniorMid-Level💰 $63,118 - $85,394 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in evaluating medical necessity for prior approval requests and nursing facility admissions, with a strong focus on accuracy and compliance with service-level agreements. Proficient in medical documentation review and process improvement within the healthcare sector.

Highest-signal resume keywords

Active North Carolina Registered Nurse LicenseClinical Experience in Long-Term CareMedical Documentation ReviewProcess Improvement AnalysisMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Necessity EvaluationPrior Approval ReviewSurgical Care ExperienceClinical Research ExperienceDocumentation Verification

Soft Skills

Strong Verbal CommunicationStrong Written CommunicationJudgment and Decision-Making

Tools & Technologies

Microsoft OfficeOutlookNCTracks

Certifications & Qualifications

Active North Carolina Registered Nurse LicenseCompact License

Industry Keywords

Long-Term CareMedicaid Business ProcessesQuality AssuranceHealthcare ComplianceConfidential Clearance

About the role

Key responsibilities & impact

Evaluate the appropriateness of beneficiaries’ admission to nursing facilities
Evaluate the medical necessity of surgical and medical prior approval requests, including transplants, out-of-state evaluations, and surgeries
Verify documentation supporting medical necessity of prior approval requests for long-term care facility admissions
Evaluate the accuracy and timeliness of documentation submitted for surgeries and medical care prior approval requests
Complete at least 30 prior approval reviews daily
Achieve greater than 95% accuracy on quality assurance reviews
Complete reviews within 24–72 hours to meet service-level agreements
Update the system with prior approval decisions within 7 business days
Contribute to process improvements

Requirements

What you’ll need

Active North Carolina Registered Nurse license or Compact license
At least 2 years of clinical experience in long-term care and medical/surgical care
3–5 years of work experience
Knowledge of Microsoft Office and Outlook
Experience with medical documentation and reviews
Knowledge of NCTracks preferred
Knowledge of North Carolina Division of Medicaid business processes preferred
Clinical medical, surgical, and nursing facility experience preferred
Clinical research experience preferred
Ability to apply policy guidelines using professional knowledge, judgment, and skills
Ability to analyze processes and contribute to improvements
Comfort with technology and changes in technology
Strong verbal and written communication skills
Confidential clearance currently required
U.S. citizenship not required

Benefits

Comp & perks

Medical plan options, including plans with Health Savings Accounts
Dental plan options
Vision plan
401(k) plan with pre-tax and post-tax contributions and company match
Full flex work weeks where possible
Paid vacation, sick, personal, holiday, parental, military, bereavement, and jury duty leave
Typically 15 days of paid leave per calendar year
10 paid holidays per year
Up to 160 hours of paid family leave in a rolling 12-month period for eligible employees
Short- and long-term disability benefits
Life insurance
Accidental death and dismemberment insurance
Personal accident insurance
Critical illness insurance
Business travel and accident insurance