Trident BPO

Claims Specialist

• Review, analyze, and process complex self-funded medical claims from start to finish.
• Utilize the WLT system daily to adjudicate claims, ensuring all coding, billing, and pricing rules are applied correctly.
• Verify patient eligibility, benefit limits, and plan coverage exclusions based on specific self-funded plan documents.
• Identify and investigate claims requiring additional information, such as coordination of benefits (COB), subrogation, or medical necessity reviews.
• Maintain strict compliance with all federal and state regulations, including HIPAA and ERISA guidelines.
• Meet or exceed established quality accuracy and production turnaround standards.

Medical Claims Examiner

Accountant

• Prepare routine monthly journal entries under the direction of the Controller — accruals, prepaid amortization, depreciation, corrections, and reclassifications.
• Ensure entries are properly coded to the correct entity, account, and cost center per company policy.
• Maintain supporting documentation for all journal entries — clean workpapers that can be reviewed by the Controller or auditors without explanation.
• Identify and flag discrepancies or unusual items to the Controller promptly rather than leaving them unresolved.
• Complete monthly bank reconciliations for all company accounts across all three entities — reconciled, documented, and submitted within the close calendar.
• Reconcile billing and vendor platform activity: match data exported from the enrollment/billing platform to the general ledger and identify any variances.
• Reconcile vendor statements monthly for key AP vendors; flag and escalate discrepancies.
• Assist with claims disbursement reconciliation for self-funded groups as directed by the Controller and VP of Plan & Payment Integrity.
• Monitor AP and AR workflows, which are largely automated — review the exception queue, ensure timely processing, and escalate items that fall outside normal parameters.
• Review AP aging report monthly; identify invoices past terms and bring to Controller's attention.
• Review AR aging report monthly; flag overdue client balances and coordinate with operations as directed.
• Process manual payments or adjustments when required, following established approval workflows.
• Maintain accurate and consistent records across all three CWB entities — CWB Holdings, CWB Administrators, and any related entities — following entity-specific accounting policies.
• Apply proper intercompany coding for transactions that span entities and flag any items that need intercompany elimination entries.
• Follow the Controller's documented policies and procedures for each entity without deviation; surface questions immediately rather than making unsupported judgment calls.

Medical Claims Examiner

Senior Accountant