Coordinator 2 - Arbitration

Description & Requirements

Maximus is currently seeking a Coordinator 2 to join our New York State Arbitration team. This is a remote opportunity. 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.

Essential Duties and 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 those cases deemed complex in nature or requiring adjudication; apply established procedures where the nature of the system, feasibility, computer equipment and reporting tools have not already been decided. - Track and meet required deadlines for complex cases or other assigned tasks. - Assist leadership through research of data and/or authoring reports. - Analyze data using all applicable state law, state regulations, process documents, and other sources as defined by the client contract. - Work independently on specific situations or on a team to resolve problems and deviations according to current established practices; and obtains advice where precedents are unclear or not available from the client. - Answer and respond to phone calls/emails from participants in the Independent Medical Review process. - Assist others or provide on-the-job training or act as a mentor 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 eligibility determinations based on applicable guidelines, regulations, and case-specific facts. - Identify discrepancies, inconsistencies, and missing information across multiple sources of documentation. - Research and evaluate complex cases that require independent judgment and problem-solving.

- High School Degree or equivalent required. - 2-4 years of related professional experience required.

- 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 where information may be incomplete or conflicting. - Excellent attention to detail, organizational skills, and decision-making abilities. - Ability to work a schedule between the hours of 8:00am - 5:30pm EST Monday - Friday required. Please note: For this position Maximus will provide equipment to use. Home Office Requirements: - Internet speed of 25mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net) - Minimum 5mpbs upload speed - Connectivity to the internet via Category 5 or 6 ethernet patch cable to the home router - Private and secure work area and adequate power source - Must currently and permanently reside in the Continental US - Must have a smartphone which will be required to log into Maximus systems

Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.