Senior Healthcare Claims Processor

General Dynamics Information Technology

. Review, analyze, evaluate, process, and adjudicate professional, facility, complex, and high-dollar medical claims .

Posted 10/27/2026full-timeRemote • United StatesSenior💰 $19 - $25 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates extensive experience in processing complex medical claims, including adjudication, denial resolution, and compliance with federal regulations. Proficient in developing training materials and workflows to enhance claims processing accuracy and efficiency.

Highest-signal resume keywords

5+ Years Experience Processing Medical ClaimsStrong Knowledge of ICD-10, CPT, HCPCSExperience Resolving Claim Denials and AppealsProficiency with Microsoft Office and Claims Processing SystemsMBI (T2) Public Trust Clearance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationClaims ProcessingRegulatory ComplianceData SecurityAnalytical SkillsProblem-Solving SkillsWorkflow DevelopmentQuality ControlPayer Policy InterpretationHigh-Volume Accuracy

Soft Skills

MentoringCoachingCustomer-Service Mindset

Industry Keywords

Medical ClaimsClaim LifecycleBilling RulesReimbursement RequirementsEscalation PathsOperational ImprovementsTraining ProgramsAudit RequestsRoot-Cause AnalysisKnowledge Gaps

About the role

Key responsibilities & impact

Review, analyze, evaluate, process, and adjudicate professional, facility, complex, and high-dollar medical claims
Apply program guidelines, reimbursement requirements, billing rules, modifiers, benefit limitations, regulatory guidance, payer policies, and federal regulations
Resolve escalated claim issues, variances, exceptions, discrepancies, denials, appeals, and complex adjudication questions
Provide day-to-day technical guidance to claims processors on complex adjudication scenarios
Mentor and coach claims processors and peers
Ensure accuracy, timeliness, compliance, privacy, data security, and service-level adherence
Define and maintain claims workflows, operating procedures, escalation paths, and quality controls
Translate claims policies and system rules into repeatable processing instructions
Recommend operational improvements and assist with standard operating procedure updates
Support training programs and develop job aids, desk guides, examples, and knowledge-check materials
Identify knowledge gaps and recommend targeted training interventions
Participate in claims quality reviews, calibration sessions, audits, and root-cause analysis
Document claim decisions and support internal and external audit requests
Monitor emerging trends and propose changes to training, processes, or system rules

Requirements

What you’ll need

Minimum 5 years of hands-on experience processing medical professional and facility claims, including complex and high-dollar claims
Strong working knowledge of ICD-10, CPT, HCPCS, revenue codes, and modifiers
Understanding of the full claim lifecycle: intake, review, adjudication, reimbursement, adjustments, denials/rejections, and escalations
Demonstrated experience interpreting and applying payer policies and federal regulations
Experience resolving claim denials, appeals, and complex adjudication questions
High accuracy in high-volume environments
Strong analytical and problem-solving skills
Proficiency with Microsoft Office and claims processing systems
Ability to interpret and apply program policies, payer rules, and federal regulations
Commitment to ongoing training and staying current on industry standards, technology, and regulatory changes
Experience with claim denial resolution and appeals workflows
Customer-service mindset
MBI (T2) public trust/other required clearance

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, and personal time
Paid holidays
Paid parental, military, bereavement, and jury duty leave
Typically 15 days of paid leave per calendar year
Typically 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
Remote work
Identity verification and security process using advanced biometrics and artificial intelligence