Call Center Specialist

At least sixteen (16) Medicaid related Call Center Specialists / Electronic Data Interchange Coordinators are needed for a long-term project in DC. These positions are 100% onsite and located downtown, near Farragut North Metro Station.

The Midtown Group is teaming up with a leading technology company to support a D.C. government department that offers its residents a Medicaid program. Our collective goal is to modernize and optimize DC's Medicaid program while offering outstanding customer support. Our venture is focused on improving outcomes, enhancing provider experiences, and safeguarding program integrity. For this project, our partner will provide technology, and we will provide people and expertise across several functions, including contact center operations.

Our Electronic Data Interchange Coordinators / Call Center Representatives will support D.C. medical providers who need assistance with invoices and payments for service they provide DC Medicaid recipients.

These positions are in-person, located in Downtown D.C. There are no plans to move to hybrid or fully remote models. Interviews begin on Wednesday, 4/15/26, and these engagements are expected to start on May 11th.

** Excellent training will be provided but some EDI experience would be very helpful. **

EDI Healthcare Representative Role Description:

The EDI specialist serves as the primary link between the business and data-trading partners. Develops and implements general insurance and health policies in accordance with state and federal laws. Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions. Response to provider appeals and meets with trading partners and providers to resolve problems/issues. Provides directions for utilization review. Approves any remedial or recoupment actions associated with escalated claims. Advises provider review councils, states officials and works with organized healthcare groups and associations on various issues related to insurance and healthcare programs.

Activities:

· Agent answers inbound customer contacts (telephone calls / chats /email, etc.) using an automated system and responds to basic customer questions and/or forwards to appropriate personnel and provides consultancy utilizing knowledge and expertise on insurance and healthcare, and/or forwards calls to appropriate personnel.

· Answers online chat using an automated system and responds to basic customer questions and provides consultancy utilizing knowledge and expertise on insurance and healthcare.

· Agent serves as the “Gatekeeper” to our customer’s information and must have the ability to keep HIPAA information confidential and secure

· Participates productively as a member of the team in a team lead role. · Completes complex tasks, assignments and defined processes with some level of independence.

· Multiple assignments worked and completed simultaneously as directed by leadership. · Identifies, prioritizes and resolves most questions and issues independently. Answers questions of peers. Adheres to escalation protocol.

· Complies with contract requirement, business unit rules and related industry and legal regulations.

· Processes calls in a manner that ensures service level agreements (SLAs) are met or exceeded.

· Records calls, processes requests and updates account history with results of inquiry to include proper documentation.

· Interfaces with team members, management, and customers in reference to customer service issues.

· Review and recommends modification to procedures and workflow as necessary to ensure efficient and effective processing of transactions.

· Conducts outbound customer contact (telephone calls/ chats / email, etc.) to members in response to customer direction or other business needs. · Other duties as assigned.

Pre-requisites:

· Bachelor’s degree or equivalent work experience or combination of education and experience.

· A minimum of two years of previous experience for a government or private sector inbound customer contact center. (Required)

· Knowledge of basic help desk software, computer software and Microsoft Office applications.

· Problem-solving skills to bring inquiries to effective resolution.

· Customer service skills with an emphasis on written and oral communication to respond to inquiries professionally.

· EDI Experience, X-12 knowledge

· Office administrative experience and skills

· Ability to follow written policies, procedures and guidelines, and give feedback to leadership · Intermediate-level knowledge of operating systems.

· Self-motivated with time management and organizational skills. · Ability to read and interpret basic to moderately complex documents such as operation and maintenance instructions, procedure manuals and government/healthcare guidelines.

· Excellent written and verbal communication skills and customer service skills, including professional telephone skills.

Work Requirements:

· Hours of Operation: Within the hours of 7:45 AM –5:15 PM, Eastern Time, Monday - Friday candidate must be able to work any assigned 8-hour shift between these hours.

· Work environment is onsite in Washington, D.C.