Healthcare Claims Examiner

General Dynamics
United States
Workplace: HybridFull timeUSD 60,350 - 81,650 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Experience: 2+ yearsEducation: bachelorsSkills: ["Collaboration","Communication","Organizational","Analytical","Decision making","Leadership"]

Review prior approval requests for private duty nursing and durable medical equipment using Division of Health Benefits (DHB) Clinical Coverage Policy and the NCTracks system. Collaborate with team members to meet DHB service level agreement targets (20–30 reviews per day) and quality goals (95%+ monthly). Prepare clear denial summaries and additional information request documentation while applying strong organizational, analytical, and decision-making skills.

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General Dynamics
General Dynamics
2 days ago

Healthcare Claims Examiner

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Source: Company careers pageValidated by: Fursa AI
Last checked: 8 minutes agoStatus: Live

Job Summary

Review prior approval requests for private duty nursing and durable medical equipment using Division of Health Benefits (DHB) Clinical Coverage Policy and the NCTracks system. Collaborate with team members to meet DHB service level agreement targets (20–30 reviews per day) and quality goals (95%+ monthly). Prepare clear denial summaries and additional information request documentation while applying strong organizational, analytical, and decision-making skills.
Location: United States
Workplace: Hybrid
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Mid level

Key Responsibilities

  • •Perform prior approval reviews for private duty nursing and durable medical equipment requests.
  • •Utilize DHB Clinical Coverage Policy and adjudicate prior approval requests accordingly.
  • •Meet DHB service level agreement targets, including review volume and monthly quality expectations.
  • •Produce clear written denial summaries and additional information request documentation.
  • •Collaborate with team members and drive corporate goals for assigned review areas.

Pay and Benefits

Salary: USD 60,350 - 81,650 annually
Perks:Health InsuranceDentalVision401kPaid LeaveParental LeaveDisability Insurance

Key Requirements

  • •2+ years of related experience.
  • •RN License.
  • •Bachelor of Arts/Bachelor of Science or Associate Degree in Nursing.
  • •Computer and communication skills.
  • •Ability to perform prior approval reviews under the private duty nursing and durable medical equipment programs.
Experience:2+ yearsHealthcareNursingHealthcare claims
Education:Bachelor's in Nursing
Skills:CollaborationCommunicationOrganizationalAnalyticalDecision makingLeadership
Licenses:RN License
Tech Stack:NCTracks

Eligibility

Nationality:US National

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