Medical Claims Processor I

BROADWAY VENTURES, LLC

United States

Remote

USD 50,000 - 70,000

Full time

14 days+

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Benefits offered by this job

401(k) with employer matching

Health insurance

Dental insurance

Vision insurance

Life insurance

Flexible Paid Time Off (PTO)

Paid Holidays

Job summary

A health services company is seeking a Claims Processor to support the World Trade Center Health Program. In this mid-senior level role, you'll be responsible for processing complex medical claims with a focus on accuracy and compliance. The ideal candidate has a high school diploma, at least five years of relevant experience, and skills in critical thinking and problem solving. This full-time position offers the flexibility of remote work and includes a competitive benefits package.

Qualifications

Minimum of five years of experience in medical claims processing.
Familiarity with ICD-10, CPT, and HCPCS coding systems.
Experience with claim denial resolution and the appeals process.

Responsibilities

Analyze and process complex medical claims.
Ensure timely claims processing.
Collaborate with internal departments to resolve issues.

Skills

Attention to detail

Problem-solving

Communication skills

Understanding of medical terminology

Education

High school diploma or equivalent

Tools

Microsoft Office Suite

Job description

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting‑edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service‑Disabled Veteran‑Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation.

Become an integral part of a dedicated team supporting the World Trade Center Health Program. In this role, you will leverage your strong attention to detail and commitment to accuracy in processing complex medical claims. If you are eager to make a positive impact in the community through your administrative skills, we encourage you to apply.

Work Schedule

Remote
Monday through Friday, 8:30 AM to 5:00 PM EST
Must be able to work 8 AM – 5 PM Eastern Standard Time

Responsibilities

Claims Review and Processing

Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance.

Critical Analysis

Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios.

Timely Processing

Ensure prompt claims processing to meet client standards and regulatory requirements.
Identify and resolve any barriers using effective problem‑solving strategies.

Issue Resolution

Collaborate with internal departments to proactively resolve discrepancies and issues.
Use analytical skills to identify root causes and implement solutions.

Confidentiality Maintenance

Uphold confidentiality of patient records and company information in accordance with HIPAA regulations.

Detailed Record Keeping

Maintain thorough and accurate records of claims processed, denied, or requiring further investigation.

Trend Monitoring

Analyze and report trends in claim issues or irregularities to management.
Assist Team Leads with reporting to contribute to continuous process improvements.

Audit Participation

Engage in audits and compliance reviews to ensure adherence to internal and external regulations.
Critically evaluate and recommend process improvements when necessary.

Mentoring

Mentor and train new claims processors as needed.

Requirements

High school diploma or equivalent.
Minimum of five years of experience in medical claims processing, including professional and facility claims, as well as complex and high‑dollar claims.
Billing experience does not count toward the years of experience qualification.
Familiarity with ICD‑10, CPT, and HCPCS coding systems.
Understanding of medical terminology, healthcare services, and insurance procedures (experience with worker’s compensation claims is a plus).
Strong attention to detail and accuracy.
Ability to interpret and apply insurance program policies and government regulations effectively.
Excellent written and verbal communication skills.
Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
Ability to work independently and collaboratively within a team environment.
Commitment to ongoing education and staying current with industry standards and technology advancements.
Experience with claim denial resolution and the appeals process.
Ability to manage a high volume of claims efficiently.
Strong problem‑solving capabilities and a customer‑service‑oriented mindset.
Flexibility to adjust to the evolving needs of the client and program changes.

Benefits

401(k) with employer matching
Health insurance
Dental insurance
Vision insurance
Life insurance
Flexible Paid Time Off (PTO)
Paid Holidays

What to Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hire’s employment. In addition, some positions may also require fingerprinting.

Broadway Ventures is an equal‑opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

Seniority level