Healthcare Claims Examiner Senior - Dental and Orthodontic Medicaid Appeals


Drive better health outcomes for our clients as a Healthcare Claims Examiner Senior at GDIT. Here, your work will impact many as you deliver healthcare expertise and services where they are needed most. Own this opportunity to advance not just delivery of needed dental and orthodontic services, but also your personal career growth.

At GDIT, people are our differentiator. As a Healthcare Claims Examiner Senior you will help ensure today is safe and tomorrow is smarter. Our work depends on Healthcare Claims Examiner Senior joining our team to ensure North Carolina's Medicaid recipients are receiving the services they are entitled to receive.

HOW A HEALTHCARE CLAIMS EXAMINER SENIOR WILL MAKE AN IMPACT

Perform dental and orthodontic mediations for appealed prior authorizations on behalf of the client.Complete all work within all SLA requirements and timelines.Meet all quality and quantity benchmarks.Work with department leadership, Dental Director, and Orthodontic Consultant to develop process improvements and ensure cases a prepared accordingly.Participate in workgroups that address both clinical and non-clinical internal activities.

WHAT YOU’LL NEED TO SUCCEED:

Qualifications:

Current North Carolina Dental Hygiene license in good standing.5+ years of clinical dental hygiene experience.Working knowledge of Medicaid dental and orthodontic prior approval policies is a plus.Experience using NCTracks is a plus.

Skills:

Knowledge of Medicaid Prior Authorization and Claims.Excellent communication skills – verbal and written.Establish and maintain effective working relationships with all levels of staff, other business segments, and clients.Self-directed with a positive attitude.Experience working with a virtual team with variable reporting relationships.Skilled with Microsoft (Word, Excel, Power Point, Outlook, Share Point, & Teams), Zoom, and other web-based applications.

Other:

This position is currently a hybrid position with the majority of time working remotely.US Citizenship Required.

GDIT IS YOUR PLACE:

● 401K with company match
● Comprehensive health and wellness packages
● Internal mobility team dedicated to helping you own your career
● Professional growth opportunities including paid education and certifications
● Cutting-edge technology you can learn from
● Rest and recharge with paid vacation and holidays