Claims Configuration Jobs in Silver Spring, MD (NOW HIRING)

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:

Data Integrity, Documentation Reporting, Documentation Tracking, Quality Assurance Processes

Certifications:

None

Experience:

3 + years of related experience

US Citizenship Required:

No

Job Description:

The Provider Data Supervisor is the manager responsible for the strategy, operations, and outcomes of the Provider Data Management function supporting the World Trade Center Health Program (WTCHP).

This role leads a team of Provider Data Representatives to maintain accurate provider demographic, enrollment, credentialing, participation, and directory information across systems; oversees roster reconciliation; safeguards data quality that impacts claims adjudication; and drives continuous improvement and audit readiness.

The Supervisor partners closely with Provider Relations, Contracting, Credentialing, Claims Operations, and Compliance to ensure provider information is complete, accurate, timely, and aligned to organizational standards.

Key Outcomes & Success Metrics

• Directory accuracy & completeness: Meet internal standards and regulatory expectations; reduce member/provider complaints related to directory errors.
• Maintenance timeliness: Process provider updates, additions, terminations, and changes on time within SLAs; reduce backlog and cycle time.
• Data integrity: Improve audit scores; lower claimsimpacting data error rates; maintain accurate NPIs, TINs, specialties, practice locations, affiliations, licenses, EFT details.
• Roster reconciliation effectiveness: Validate rosters from healthcare delivery organizations across source systems; identify and correct discrepancies promptly to strengthen participation accuracy.
• Crossfunctional alignment: Reduce onboarding delays and enrollment exceptions through tight coordination with Credentialing, Contracting, Provider Relations, and Claims.
• Operational efficiency: Standardize procedures, leverage automation and dashboards, and demonstrate measurable gains in productivity and quality.

Essential Duties & Responsibilities

Leadership & Strategy

• Own the provider data management strategy and annual operating plan; translate organizational goals into targets, roadmaps, KPIs, and resource plans.
• Lead, coach, and develop Provider Data Representatives; set goals, conduct performance evaluations and coaching, and promote professional development.
• Establish governance for data standards, approvals, exception handling, and escalation pathways; define disciplined operating rhythms.

Provider Data Management & Lifecycle

• Oversee maintenance of provider demographics, participation, enrollment, credentialing attributes, and directory content across systems.
• Ensure timely processing of provider updates, new enrollments, terminations, and changes; validate records across operational systems to support accurate claims payment and directory publication.
• Manage data requirements across the provider lifecycle (onboarding, participation activation, recredentialing, termination) in partnership with Credentialing and Provider Relations.

Roster Reconciliation & Directory Accuracy

• Supervise routine reconciliation of provider rosters submitted by healthcare delivery organizations; validate against credentialing, enrollment, terms & conditions, claims, and directory data.
• Identify discrepancies affecting participation or operational performance; coordinate corrective actions internally and with provider organizations.
• Develop standardized reconciliation procedures, quality controls, duplicate/merge resolution rules, and steward a master "golden record."

CrossFunctional Collaboration

• Partner with Provider Network Team and Contracting to align data requirements with contracting terms, onboarding milestones, and provider communications.
• Collaborate with Credentialing to ensure records are complete and current; synchronize participation dates, required documents, and recredentialing cycles.
• Work with Claims Operations to resolve provider data discrepancies affecting reimbursement; support EDI/configuration updates and claimsimpact analyses.
• Participate in enterprise initiatives involving provider systems and operational improvements; lead provider data meetings and crossfunctional workgroups.

Risk, Compliance & Stakeholder Management

• Ensure compliance with organizational policies, privacy/security requirements, and applicable regulations impacting provider directories and data management; maintain auditready documentation.
• Participate in internal audits and quality reviews; develop and execute corrective action plans addressing identified deficiencies.
• Communicate status, risks, and recommendations to executive stakeholders; prepare materials for business reviews and governance committees.

#GDITWTCJOBS

The likely salary range for this position is $46,301 - $55,775. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

Scheduled Weekly Hours:

40

Travel Required:

Less than 10%

Telecommuting Options:

Remote

Work Location:

USA VA Falls Church

Additional Work Locations:

Total Rewards at GDIT:

Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.

Our Identity Verification Process:

As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against identity fraud. You are expected to be on camera during virtual interviews. We reserve the right to take your picture to verify your identity and prevent fraud. By proceeding, you authorize the collection, processing, and use of your biometric data for identity verification and security purposes.

About Our Work:

We are GDIT. A global technology and professional services company that delivers technology solutions and mission services to every major agency across the U.S. government, defense and intelligence community. Our 26,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50+ countries worldwide, offering leading mission-ready capabilities in AI, cloud, cyber and software development.Join our Talent Community to stay up to date on our career opportunities and events at

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Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans