Claims Analyst

At least twenty-four (24) Medicaid related Claims Analyst and Claims Processors 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.

Claims Analyst and Claims Processors will support D.C. medical providers who need assistance with Medicaid benefits.

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 Tuesday, 12/9/25, and these engagements are expected to start on 1/16/26 and may continue for up to two or three years or longer.

Key job tasks

Claims/Financial Analyst/Processors have several job responsibilities, and some of the critical ones are:

· Handle refund checks and state warrants received from healthcare providers and the State agency.

· Contact providers, verbal and in writing, to resolve check-related issues.

· Receive and respond to client inquiries.

· Responsible for handling the Accounts Receivable transfer process, setting up expenditures, setting up Accounts Receivable transactions, and placing and recoupment caps using the Medicaid system.

· Responsible for analyzing financial data to ensure accurate reporting.

· Research highly complex claims processing or financial transactions.

· Process adjustments and voids.

· Ensure SLAs are compliant with client and Midtown Group expectations

· Other duties as assigned.

Performance measurement

The Midtown Group measures performance in a number of ways, with the key ones being:

• Quality Assurance assessments: may have their calls monitored and assessed at any time during a shift. We and our partner monitor and assess our CSRs regularly. CSRs are expected to maintain or exceed a QA pass rate of 90% . Calls are considered to have failed if a CSR misses or incorrectly performs any critical element of the job. These items are well-covered in training and reinforced during pre-shift and individual coaching sessions.
• Call handling metrics are a good measure of performance and the three focus areas are:
• Percent of your shift that you are either on a call or available to take a call.
• Length of call. We are here to provide efficient, professional assistance, so a consistent track record of very long or very short calls is generally frowned upon.
• Percent of calls that you transfer. This often indicates that a CSR is unable or unwilling to assist callers.
• Attendance

Minimum requirements

· High School Diploma or equivalent, 2-year post-high school Degree, or bachelor’s degree.

· A minimum of two years of previous experience for a government or private sector operations center in a similar or related field.

· Two to four years of working experience in claims processing and financial analysis.

· Organization skills to balance/prioritize work with the ability to multi-task.

· Proficiency with 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 professionally and efficiently respond to inquiries.

Other important skills

The ability to provide operational excellence is extremely important to both the Midtown Group and our client. If you have the service gene – if helping others is in your DNA – we are happy to have you join us.

Our most effective and successful Claims/Financial Analyst/Processors exhibit the following skills:

· Conduct themselves with professionalism, empathy, patience, courtesy, and tact, at all times.

· Communicate effectively, clearly, and professionally.

· Quickly and effectively process transactions and analyze financial data, to a high standard. Operational quality is very important to us.

· Know when and how to collaborate and escalate to quickly and effectively address and resolve issues.

· Effectively collect and handle sensitive data and personal information, as needed.

· Exercise good judgment at all times.

· Deal well with conflict, as well as complex and emotional situations.

· Be flexible, and able to work independently.

Hours, project duration, etc.

The contact center operating hours are Monday through Friday, from 8:00am to 5:00pm ET. However, schedules will be between the hours of 7:45am to 5:15pm ET, to allow for pre-shift sessions and last-minute contacts/wrap up.

The contact center is closed on Federal holidays. Candidates must be able to work 40 hours per week.

The base period for this contract is through November 2026, with two further annual option periods. So, this contract could run until November 2028.