Healthcare Claims Examiner Dental Hygienist (NC Dental Hygiene license required)

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Public Trust/Other Required:

None

Job Family:

Ancillary Health

Job Qualifications:

Skills:

Computer Literacy, Dental Hygiene, Dental Imaging, Microsoft Applications, Pre Approvals

Certifications:

None

Experience:

5 + years of related experience

US Citizenship Required:

No

Job Description:

GDIT NCMMIS is a claims processing system for the North Carolina Department of Health and Human Services (NC DHHS), supporting North Carolina citizens enrolled in state-administered benefit plans. The program is seeking a Dental Prior Approval Reviewer to evaluate dental prior approval requests for North Carolina Medicaid. This role requires extensive use of computer systems, claims processing applications, and electronic documentation tools to analyze requests, apply Medicaid policy, and ensure accurate and timely determinations in a high-volume, technology-driven environment.

Minimum Requirements:

• Requires active North Carolina license as a Registered Dental Hygienist (RDH).

• 5+ years of clinical dental hygiene experience.

• Demonstrated ability to effectively use computers, electronic systems, and digital tools.

The ideal candidate will have:

• Ability to work independently in a remote or office-based, technology-dependent environment while meeting service level agreements and individual performance standards.
• Strong proficiency with Microsoft Office applications (Word, Excel, OneNote) and Microsoft Outlook for documentation, analysis, and communication.
• Extensive experience using Windows-based computer applications and navigating multiple systems simultaneously.
• Experience using NCTracks or similar Medicaid claims processing systems.
• Thorough knowledge of Medicaid dental policy and prior approval processes.
• High level of proficiency in general computer skills, including data entry, electronic record review, system navigation, and use of common software and digital tools required for claims examination.

The likely salary range for this position is $62,050 - $83,950. 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 NC Raleigh - 5444 Wade Park Blvd (NCS018)

Additional Work Locations:

Any Location / Remote

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. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee’s date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. 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.

We are GDIT. A global technology and professional services company that delivers consulting, technology 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 capabilities in digital modernization, AI/ML, Cloud, Cyber and application development. Together with our clients, we strive to create a safer, smarter world by harnessing the power of deep expertise and advanced technology.

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Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans