Process and adjudicate complex medical claims supporting the World Trade Center Health Program. This role calls for accuracy, judgment, and high-volume claims expertise to ensure timely, compliant outcomes.
About Broadway Ventures
Broadway Ventures is an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business delivering program management, technology services, and consulting solutions to government and private-sector partners. We build efficient, compliant systems that drive mission success and operational excellence.
Schedule
- Remote
- Monday–Friday
- 8:30 AM–5:00 PM EST (must be available)
Responsibilities
- Review and process complex medical claims accurately and within program guidelines
- Apply policy knowledge and critical thinking to adjudicate claims
- Meet client and regulatory timelines for high-volume claim loads
- Resolve claim barriers and discrepancies through cross-department collaboration
- Ensure HIPAA compliance and protect confidential records
- Maintain detailed documentation and tracking
- Identify trends and support reporting for continuous improvement
- Participate in audits and implement process refinements
- Mentor and support new processors as needed
Requirements
- High school diploma or equivalent
- Minimum 5 years experience in medical claims processing
(Note: billing experience does not count toward requirement) - Experience with professional, facility, complex, and high-dollar claims
- Knowledge of ICD-10, CPT, and HCPCS coding systems
- Strong grasp of medical terminology and insurance procedures; workers’ comp a plus
- Proficiency in Microsoft Office Suite
- Experience resolving claim denials and appeals
- Ability to manage large claim volume efficiently
- Excellent written and verbal communication skills
- Strong attention to detail, accuracy, and problem-solving skills
- Able to work independently and in team environments
- Reliable high-speed internet with ethernet capability
Benefits
- Medical, dental, and vision insurance
- 401(k) with employer match
- Life insurance
- Flexible Paid Time Off
- Paid holidays
Happy Hunting,
~Two Chicks…