Fraud Claims Operations Representative Jobs in Alabama

Type of Requisition:

Pipeline

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Public Trust/Other Required:

Other

Job Family:

Ancillary Health

Job Qualifications:

Skills:

Claims Operations, Healthcare Claims Processing, Medicaid Claims, Medicaid Policy, People Management

Certifications:

None

Experience:

5 + years of related experience

US Citizenship Required:

No

Job Description:

At General Dynamics Information Technology (GDIT), we support state agencies in streamlining Medicaid Enterprise Systems (MES) by delivering operational efficiency and excellence. We are seeking a Claims Operations Manager to oversee and optimize the day-to-day MES claims processing operations under the Fiscal Agent Operations function. This role involves managing the processing, adjudication, and resolution of healthcare claims for Medicaid beneficiaries while ensuring operational compliance and consistent service delivery.

As the Claims Operations Manager, you will lead a team responsible for ensuring that Medicaid claims processing operations meet performance standards, comply with state and federal regulations, and deliver a high degree of accuracy and timeliness.

Responsibilities

• Manage and oversee day-to-day MES claims operations, ensuring timely and accurate processing, adjudication, and resolution of Medicaid claims according to guidelines and contractual Service Level Agreements (SLAs).
• You will act as a thought partner to the leadership team to provide support and counsel for operations management, communications, initiatives and projects.
• You should be a self-starter with outstanding organization and communication skills; fast-paced environment.
• Understand strategic financials regarding areas of oversight.
• Proven ability to build strong partnerships with colleagues, desire to be flexible and think proactively, strategically, and analytically about diverse business solutions and leading professional working groups.
• Ability to make critical decisions with limited guidance while ensuring visibility into those decisions.
• A demonstrated understanding of Medicaid support operations and an appreciation for how to prioritize among demands and balance the levers that make a complex business run smoothly and productively.
• Manages Provider Enrollment operations for the program, including optimizing resources to facilitate SLA deliverables and maximize efficient operations.
• Manages change management efforts and reporting to optimize SLAs and ensure optimization of resources.
• Serve as lead cross departmental deliverables for operations, including internal and external audits, business continuity, and other program operations deliverables.
• Serve as a resource for operational managers and assist with training and mentoring operational managers regarding key operational processes.
• Lead cross departmental operational efforts for internal and external quality assessments, audits and surveys.
• Lead cross departmental communication initiatives to both internal and external stakeholders, including community engagement efforts and efforts to facilitate employee engagement.
• Manage and oversee key departments, including training and operational data efforts to optimize efficiencies and ensure effective operations.
• Oversee and coordinate NCQA CVO efforts and all supporting efforts.
• Manages and optimizes customer and key stakeholder relationships, including escalations and developing processes to facilitate timely management of provider enrollment related escalations.

Required Skills and Qualifications

• Education: Bachelor's Degree in related technical, scientific, business, health or a related discipline
• Required Experience: 5+ years of related experience
• Required Skills and Abilities: Medicaid Operations Leadership Support , Project Management Skills, Provider Enrollment Management Skills and Experience, NCQA CVO knowledge and experience.
• Demonstrated ability to communicate issues, impacts, and corrective actions
• Preferred Skills: SharePoint, Excel, PMO, PowerPoint
• Strong knowledge ofMedicaid Fee-for-Service (FFS), and Managed Care claims processes.
• Experience with healthcare claims software platforms and operational workflows.
• Experience inclaims repricingand interaction with national coding standards (e.g., CPT, ICD-10, HCPCS).

Preferred Qualifications

• Familiarity with Program Integrity (PI) workflows, fraud/waste/abuse detection, and encounter data validation.
• Proficiency with claims adjudication systems, reporting tools, and analytics platforms like Tableau or Power BI.
• Familiarity with Medicaid Information Technology Architecture (MITA) and CMS certification processes.
• Highly desirable certifications such asCertified Medical Reimbursement Specialist (CMRS)or lean process improvement certifications (e.g., Six Sigma).

Additional Information:

Work Arrangements: Hybrid, based in the Montgomery, AL area. Expect to be in office at least one day a week. Travel outside the area may be required.

Security: A background check will be required.

Timeline: This is a contingent job posting. Work is not expected to begin until AUGUST 2026 or later.

Work visa sponsorship will not be provided for this position.

GDIT IS YOUR PLACE
At GDIT, the mission is our purpose, and our people are at the center of everything we do.
Growth: AI-powered career tool that identifies career steps and learning opportunities
Support: An internal mobility team focused on helping you achieve your career goals
Rewards: Comprehensive benefits and wellness packages, 401K with company match, and competitive pay and paid time off
Flexibility: Full-flex work week to own your priorities at work and at home
Community: Award-winning culture of innovation and a military-friendly workplace
OWN YOUR OPPORTUNITY
Explore an enterprise IT career at GDIT and you'll find endless opportunities to grow alongside colleagues who share your desire to drive operations forward.

The likely salary range for this position is $111,155 - $150,385. 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:

Hybrid

Work Location:

USA AL Montgomery

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