Sr Admin - Arbitration

Description & Requirements

Maximus is currently hiring for an Sr.

Admin - Arbitration to join our State Arbitration team.

This is a remote opportunity.

The Sr.

Admin will provide comprehensive administrative support to both the New Jersey and New York IDR teams.

This role involves participation in daily operations, coordinating communications, and accurate data input to ensure the smooth functioning of the IDR process.

This includes updating and maintaining reports, creating and closing cases, and well as reviewing invoices.

This is a fast-paced, deadline-driven position.

Essential Duties and Responsibilities:
- Maintain updated knowledge of project and corporate policies and procedures as referenced in the employee manual and other desk procedures for the position

- Function as a Subject Matter Expert in one or more process areas.

- Analyze data submitted for Independent Medical Review.

- Collect and analyze incoming data and reports from treatment providers, facilities, participants, labs and health plans to input necessary information into the system.

- Respond to incoming calls from clients, health plans, providers and enrollees regarding case status, questions about the program, and the appeals process.

- Create arbitration cases in the system.

- Send requests for information to providers and health plans.

- Close arbitration cases in the system.

- Analyze data received from providers and health plans.

Minimum Requirements

- Associate degree with 2+ years' experience.
- Experience in lieu of an Associate degree (HS Diploma or GED and 4+ years of experience) also considered.

- Ability to manage multiple tasks efficiently and maintain accurate records.

- Excellent written and verbal communication skills to interact with healthcare providers and insurance companies.

- Ability to work across multiple platforms.

- Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and healthcare billing systems.

- Ability to successfully work in a fast-paced, deadline-driven environment.

- High level of accuracy in data entry and document management.

- Ability to work independently as a part of a team remotely.

- Experience with Salesforce platform highly preferred.

- Familiarity with health insurance documentation, explanation of benefits, and/or claim forms highly preferred.

- Basic understanding of healthcare billing, CPT codes, and the No Surprises Act strongly preferred.

- Ability to work a schedule of 8:00am - 4:30pm EST Monday - Friday required.

Home Office Requirements:

- Internet speed of 20mbps 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 either Wi-Fi or 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

EEO Statement

Maximus is an equal opportunit...