Healthcare Claims Examiner

General Dynamics
Raleigh
Workplace: HybridFull timeUSD 63,118 - 85,394 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Experience: 3-5 yearsSkills: ["Communication","Professional judgment","Process analysis","Attention to detail","Comfort with technology"]

Evaluate and process prior approval requests for nursing facility admissions and surgical/medical services, ensuring medical necessity and reviewing documentation for accuracy and timeliness. Maintain daily throughput and quality targets, meet defined service-level review timelines, and update systems with decisions. Requires clinical long-term care and medical/surgical experience, an active NC RN or compact license, and strong communication while working in a hybrid environment.

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FursaFursa
General Dynamics
General Dynamics
11 hours ago

Healthcare Claims Examiner

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Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live

Job Summary

Evaluate and process prior approval requests for nursing facility admissions and surgical/medical services, ensuring medical necessity and reviewing documentation for accuracy and timeliness. Maintain daily throughput and quality targets, meet defined service-level review timelines, and update systems with decisions. Requires clinical long-term care and medical/surgical experience, an active NC RN or compact license, and strong communication while working in a hybrid environment.
Location: Raleigh
Workplace: Hybrid
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Mid level

Key Responsibilities

  • •Verify receipt of documentation supporting medical necessity for prior approval requests for long term care facility admission.
  • •Evaluate the accuracy and timeliness of documentation for prior approval requests for surgeries and medical care.
  • •Complete at least 30 prior approval reviews daily to meet performance expectations.
  • •Meet quality expectations of greater than 95% accuracy on quality assurance reviews.
  • •Complete reviews within 24–72 hours and update the system with prior approval decisions within 7 business days.

Pay and Benefits

Salary: USD 63,118 - 85,394 annually
Perks:Health InsuranceDentalVision401kPaid LeaveParental LeaveLife InsuranceDisability Insurance

Key Requirements

  • •Requires an active North Carolina Registered nurse license or Compact license with at least 2 years of clinical experience in long term care and medical/surgical care.
  • •2+ years of work experience reviewing medical documentation and prior approval requests.
  • •Requires 3–5 years of relevant work experience.
  • •Knowledge of Microsoft Office and Outlook.
  • •Knowledge or experience with NCTracks and North Carolina Division of Medicaid business processes is preferred.
Experience:3-5 years
Skills:CommunicationProfessional judgmentProcess analysisAttention to detailComfort with technology
Licenses:North Carolina Registered nurse licenseCompact license
Tech Stack:Microsoft OfficeOutlookNCTracks

Eligibility

Security Clearance:Confidential

Company Brief

General Dynamics
Provides IT, systems engineering, cybersecurity, cloud, and mission support services to U.S. federal civilian and defense agencies, delivering large-scale technology solutions and managed services for national security and government operations.
Industry: Defense Technology
Company Size: Enterprise (1,001+ employees)
Growth: Established Company
Headquarters: Tysons / Fairfax, United States
WebsiteLinkedIn