Manager - Arbitration Operations

About the role

The Manager - Arbitration Operations oversees the day-to-day administration and performance of a state-sponsored surprise billing dispute resolution program. This role leads operational teams that facilitate independent dispute resolution (IDR) and arbitration processes between healthcare providers, health plans, and other stakeholders. The Manager ensures compliance with state regulations, contract requirements, service-level agreements (SLAs), and quality standards while driving operational excellence and stakeholder satisfaction.

Responsibilities

• Manage assigned teams and staff.
• Develop, monitor, and use quality control procedures and audit criteria to ensure consistent application of contractual requirements and established policies and procedures.
• Frequent interaction with subordinate employees, customers, and/or functional peer group managers, normally involving matters between functional areas, other company divisions or units, or customers and the company.
• Provide guidance to subordinates within the latitude of established company policies.
• Recommend changes to policies and establish procedures that affect immediate organization(s).
• Perform other duties as assigned by management.
• Ability to perform comfortably in a fast-paced, deadline-orientated work environment.
• Excellent organizational, interpersonal, written, and communication skills.
• Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
• Develop and analyze operational reports, dashboards, and key performance indicators.
• Maintain comprehensive documentation and case management protocols.
• Coordinate with arbitrators, providers, health plans, and regulatory agencies throughout the dispute resolution process.
• Ensure cases are managed in accordance with applicable state laws, regulations, policies, and contractual requirements.
• Monitor program performance against contractual SLAs and performance guarantees.
• Perform other duties as assigned by management.
• Operational Leadership: Manage daily operations of the surprise billing arbitration program, ensuring timely and accurate case processing. Lead, coach, and develop a team of supervisors, analysts, coordinators, and arbitration specialists. Monitor workloads, staffing levels, productivity, and quality performance metrics. Establish and implement operational procedures, workflows, and best practices. Identify process improvement opportunities and implement solutions to increase efficiency and compliance.
• Program Administration: Oversee intake, review, assignment, tracking, and resolution of arbitration cases. Manage assigned staff. Provide guidance to subordinates within the latitude of established company policies. Recommend changes to policies and establish procedures that affect immediate organization(s).
• Compliance & Quality Assurance: Ensure adherence to state surprise billing regulations, privacy requirements, and program standards. Monitor quality assurance activities and implement corrective action plans when needed. Conduct audits and reviews to ensure consistency and accuracy in program administration. Support regulatory reporting and compliance monitoring activities.
• Client & Stakeholder Management: Serve as a primary operational contact for state agency representatives and key stakeholders. Facilitate meetings, program reviews, and performance discussions. Resolve escalated issues and stakeholder concerns in a timely and professional manner. Foster collaborative relationships with healthcare providers, payers, legal representatives, and dispute resolution entities.
• Performance Management & Reporting: Develop and analyze operational reports, dashboards, and key performance indicators. Monitor program performance against contractual SLAs and performance guarantees. Present performance results, trends, risks, and recommendations to senior leadership. Support forecasting, capacity planning, and resource management activities.

Qualifications

• Bachelor's degree in relevant field of study and 5+ years of relevant professional experience required, or equivalent combination of education and experience.
• Familiarity with Appeals & Hearings is required. Expertise within the Hearings & Appeals function is strongly preferred.
• Experience administering surprise billing, independent dispute resolution (IDR), arbitration, or healthcare appeals programs.
• Experience managing client-facing operations and performance metrics.
• Strong understanding of healthcare reimbursement, claims processing, or payer-provider relations.
• Demonstrated experience with process improvement and operational oversight.
• Knowledge of and experience working with explanation of benefits and claim forms.
• Experience in matters related to healthcare billing and healthcare reimbursement.
• Ability to work a schedule between the hours of 8:00am - 6:00pm EST Monday - Friday.

Skills and Abilities

• Strong leadership, coaching, and team development skills.
• Excellent analytical and problem-solving abilities.
• Ability to interpret regulations, policies, and contractual requirements.
• Strong organizational and project management skills.
• Excellent written, verbal, and presentation communication skills.
• Proficiency with case management systems, reporting tools, and Microsoft Office applications.
• Ability to manage multiple priorities in a fast-paced, deadline-driven environment.

Benefits

Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off.

Pay

Minimum Salary: $80,000.00
Maximum Salary: $90,000.00