Coordinator 2 - Arbitration

This is a remote opportunity based in the Continental US, with required work hours between 8:00 AM – 5:30 PM EST, Monday – Friday. Maximus will provide equipment and requires a home office with a private, secure work area; 25 Mbps+ download speed (50 Mbps for shared connections), 5 Mbps+ upload speed, wired ethernet connectivity, and adequate power. A smartphone is also required for system access.

About the Role

The Coordinator is responsible for reviewing and analyzing healthcare claims documentation to support eligibility determinations and case resolution. This role requires strong critical-thinking skills, attention to detail, and the ability to evaluate complex information that may not follow a straightforward or linear pattern.

Responsibilities

• Function as a Subject Matter Expert in one or more process areas.
• Analyze data submitted for Independent Medical Review.
• Conduct fact-finding and analyses on complex cases requiring adjudication; apply established procedures where systems, feasibility, or tools are not predefined.
• Track and meet required deadlines for complex cases or assigned tasks.
• Assist leadership through research and report authoring.
• Analyze data using state law, regulations, process documents, and client contract requirements.
• Work independently or on a team to resolve problems and deviations according to established practices; seek advice where precedents are unclear.
• Respond to phone calls and emails from participants in the Independent Medical Review process.
• Provide on-the-job training or mentorship to production staff.
• Review and interpret Explanation of Benefits (EOBs), HCFA/CMS-1500 claim forms, UB-04 forms, and other healthcare-related documentation.
• Analyze eligibility information and make accurate determinations based on applicable guidelines, regulations, and case-specific facts.
• Identify discrepancies, inconsistencies, and missing information across multiple documentation sources.
• Research and evaluate complex cases requiring independent judgment and problem-solving.

Requirements

• High School Diploma or equivalent required.
• 2–4 years of related professional experience.
• Strong knowledge of healthcare claims processing, including EOBs, HCFA/CMS-1500 claim forms, and related billing documentation.
• Demonstrated ability to make eligibility determinations using critical analysis and independent judgment.
• Strong analytical and investigative skills with the ability to connect information from multiple sources.
• Ability to think beyond linear processes and navigate complex scenarios with incomplete or conflicting information.
• Excellent attention to detail, organizational skills, and decision-making abilities.

Pay

Hourly pay range: $20.00 – $23.50.

Benefits

• Health insurance coverage.
• Life and disability insurance.
• Retirement savings plan.
• Paid holidays and paid time off.
• Short- and long-term incentives.
• Program-specific awards.