-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Rock Springs, US-WY
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:50
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Eau Claire, US-WI
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:46
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Richmond, US-VA
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:43
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Roanoke, US-VA
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:42
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Charleston, US-WV
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:42
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Morgantown, US-WV
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:41
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Seattle, US-WA
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:40
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Spokane, US-WA
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:36
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Salt Lake City, US-UT
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:33
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Lubbock, US-TX
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:33
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Bennington, US-VT
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:32
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: St. George, US-UT
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:31
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Tysons, US-VA
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:27
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Burlington, US-VT
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:25
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Dallas, US-TX
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:21
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Nashville, US-TN
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:18
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: San Antonio, US-TX
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:17
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Memphis, US-TN
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:17
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Rapid City, US-SD
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:16
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Houston, US-TX
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:15
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Newport, US-RI
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:15
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Providence, US-RI
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:14
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Sioux Falls, US-SD
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:14
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
....Read more...
Type: Permanent Location: Columbia, US-SC
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:13
-
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.
Minimum Requirements
- 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
EEO Statement
Maximus is an equal opportu...
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Type: Permanent Location: Charleston, US-SC
Salary / Rate: Not Specified
Posted: 2026-08-19 10:07:12
