Claims Resolution Customer Service Agent

Medicaid Claims Analyst & Claims Processor

100% Onsite | Downtown Washington, D.C. (Farragut North Metro)
Long-Term Contract Opportunity (Through 2028)

The Midtown Group is partnering with a leading technology firm to support a District of Columbia government agency responsible for delivering Medicaid services to D.C. residents. Together, we are modernizing and strengthening the Medicaid program—improving outcomes, enhancing provider experiences, and protecting program integrity.

We are seeking at least 24 experienced Medicaid Claims Analysts and Claims Processors to support this mission. These are fully onsite positions located in downtown D.C. There are no plans for hybrid or remote work.

Interviews begin December 9, 2025
Anticipated start date: January 16, 2026
Assignments are expected to continue two to three years or longer, with funding currently projected through November 2028.

The Role

In this role, you will support D.C. medical providers by resolving Medicaid claims, payment, and financial issues with accuracy, professionalism, and efficiency. You will work closely with providers, internal teams, and government partners to ensure claims are processed correctly and service levels are met.

Key Responsibilities

• Process and research Medicaid claims, financial transactions, adjustments, and voids
• Handle refund checks and state warrants received from providers and government agencies
• Communicate with providers verbally and in writing to resolve payment and check-related issues
• Respond to provider and client inquiries in a professional, customer-focused manner
• Manage Accounts Receivable activities, including:
• Setting up expenditures and AR transactions
• Applying recoupment caps within the Medicaid system
• Analyze financial data to ensure accuracy, compliance, and proper reporting
• Research and resolve highly complex claims and financial discrepancies
• Ensure compliance with SLAs, quality standards, and client expectations
• Perform other related duties as assigned

Performance Expectations

Performance is measured across several key areas:

Quality Assurance

• Calls and work products may be reviewed at any time
• Expected QA pass rate: 90% or higher
• Critical errors result in a failed QA review (training and coaching provided)

Call & Productivity Metrics

• Availability during scheduled shifts
• Appropriate call handling times (consistently very short or very long calls are discouraged)
• Minimal call transfers, demonstrating ownership and issue resolution

Attendance & Reliability

• Consistent, dependable attendance is essential

Minimum Qualifications

• High school diploma or equivalent (Associate’s or Bachelor’s degree preferred)
• 2 years experience in a government or private-sector operations or contact center environment
• 2–4 years of experience in claims processing and/or financial analysis
• Strong organizational and multitasking skills
• Proficiency with Microsoft Office and basic case or help-desk systems
• Strong problem-solving and analytical abilities
• Excellent written and verbal communication skills
• A customer service mindset with a focus on professional, effective resolution

What Sets Top Performers Apart

Our most successful Claims Analysts and Processors:

• Demonstrate professionalism, empathy, patience, and sound judgment at all times
• Communicate clearly and confidently with providers and stakeholders
• Process transactions and analyze financial data accurately and efficiently
• Know when to collaborate or escalate to resolve issues quickly
• Handle sensitive and confidential information with care
• Remain calm and effective in complex or emotionally charged situations
• Work independently while adapting to changing priorities

If helping others is in your DNA and you take pride in operational excellence, you will thrive in this role.

Schedule & Work Environment

• Monday–Friday, 40 hours per week
• Contact center hours: 8:00 a.m. – 5:00 p.m. ET
• Shifts scheduled between 7:45 a.m. – 5:15 p.m. ET to accommodate pre-shift briefings and wrap-up
• Closed on Federal holidays
• 100% onsite in Downtown Washington, D.C.

Project Duration

• Base contract through November 2026
• Two additional one-year option periods
• Potential project duration through November 2028

Job Types: Full-time, Contract, Temporary

Pay: $24.00 - $25.00 per hour

Expected hours: 40 per week

Ability to Commute:

• Washington, DC 20036 (Required)

Work Location: In person

Salary : $24 - $25