-
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: Tampa, US-FL
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:17
-
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: Tallahassee, US-FL
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:15
-
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: Miami, US-FL
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:14
-
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: Atlanta, US-GA
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:14
-
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: Dover, US-DE
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:13
-
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...
....Read more...
Type: Permanent Location: Colorado Springs, US-CO
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:10
-
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: Wilmington, US-DE
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:08
-
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: Hartford, US-CT
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:08
-
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: Jacksonville, US-FL
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:07
-
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: Los Angeles, US-CA
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:06
-
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: Bridgeport, US-CT
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:06
-
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: Fort Smith, US-AR
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:05
-
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 Francisco, US-CA
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:04
-
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: Sacramento, US-CA
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:04
-
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: Denver, US-CO
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:03
-
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: Mobile, US-AL
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:02
-
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 Diego, US-CA
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:02
-
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: Montgomery, US-AL
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:01
-
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: Birmingham, US-AL
Salary / Rate: Not Specified
Posted: 2026-08-19 10:06:01
-
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: Little Rock, US-AR
Salary / Rate: Not Specified
Posted: 2026-08-19 10:05:59
-
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: Phoenix, US-AZ
Salary / Rate: Not Specified
Posted: 2026-08-19 10:05:56
-
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: Tucson, US-AZ
Salary / Rate: Not Specified
Posted: 2026-08-19 10:05:56
-
Key Responsibilities
• Act as the principal technical authority for integration engineering across Maximus UK, providing deep leadership across Boomi-based integration solutions.
• Define and maintain integration engineering standards, patterns, guardrails, and best practices for system-to-system integrations, APIs, events, and workflows.
• Provide hands-on technical leadership for the design and implementation of complex integrations built on Boomi and related integration technologies.
• Design scalable integration architectures connecting cloud services, SaaS platforms, enterprise applications and data platforms.
• Drive adoption of modern integration patterns, including API-first design, event-driven architectures, microservices-aligned integrations, and reusable integration components.
• Guide the team's technical direction, improve engineering quality, and support consistent delivery standards.
• Lead technical discovery sessions, design workshops, and integration architecture discussions with business stakeholders, architects, product teams, and engineering colleagues.
• Translate business and operational requirements into robust integration designs and implementation plans that balance speed, resilience, supportability, and long-term value.
• Establish governance approaches for integration code quality, peer review, CI/CD, testing, deployment, observability, and operational readiness.
• Ensure integrations are secure by design, with appropriate controls for authentication, authorisation, encryption, auditability, and protection of sensitive data including PII and PHI.
• Drive the development of reusable integration components, frameworks, and reference implementations that improve delivery speed, quality, and consistency across projects.
• Mentor and develop integration engineers, raising technical capability, architectural understanding, and engineering discipline across the integration team.
• Evaluate opportunities to simplify the integration and automation estate, reduce platform dependency, and introduce more cost-effective and flexible integration approaches.
• Collaborate with automation specialists (e.g.
Automation Anywhere engineers) to define clear boundaries between integration and automation layers and ensure coherent end-to-end designs.
• Monitor technology trends, platform capabilities, and industry best practice in integration engineering, using insight and evidence to evolve the organisation's integration roadmap
Essential Skills - What You'll Bring
• Significant experience in integration engineering.
• Strong hands-on expertise with the Boomi Integration Platform, including process design, orchestration, integration development, API exposure, and enterprise deployment patterns.
• Proven experience designing scalable enterprise integration architectures across cloud services, SaaS platforms, enterprise applications and APIs.
• Experience delivering complex multi-s...
....Read more...
Type: Permanent Location: Eau Claire, US-WI
Salary / Rate: Not Specified
Posted: 2026-08-19 10:05:55
-
Key Responsibilities
• Act as the principal technical authority for integration engineering across Maximus UK, providing deep leadership across Boomi-based integration solutions.
• Define and maintain integration engineering standards, patterns, guardrails, and best practices for system-to-system integrations, APIs, events, and workflows.
• Provide hands-on technical leadership for the design and implementation of complex integrations built on Boomi and related integration technologies.
• Design scalable integration architectures connecting cloud services, SaaS platforms, enterprise applications and data platforms.
• Drive adoption of modern integration patterns, including API-first design, event-driven architectures, microservices-aligned integrations, and reusable integration components.
• Guide the team's technical direction, improve engineering quality, and support consistent delivery standards.
• Lead technical discovery sessions, design workshops, and integration architecture discussions with business stakeholders, architects, product teams, and engineering colleagues.
• Translate business and operational requirements into robust integration designs and implementation plans that balance speed, resilience, supportability, and long-term value.
• Establish governance approaches for integration code quality, peer review, CI/CD, testing, deployment, observability, and operational readiness.
• Ensure integrations are secure by design, with appropriate controls for authentication, authorisation, encryption, auditability, and protection of sensitive data including PII and PHI.
• Drive the development of reusable integration components, frameworks, and reference implementations that improve delivery speed, quality, and consistency across projects.
• Mentor and develop integration engineers, raising technical capability, architectural understanding, and engineering discipline across the integration team.
• Evaluate opportunities to simplify the integration and automation estate, reduce platform dependency, and introduce more cost-effective and flexible integration approaches.
• Collaborate with automation specialists (e.g.
Automation Anywhere engineers) to define clear boundaries between integration and automation layers and ensure coherent end-to-end designs.
• Monitor technology trends, platform capabilities, and industry best practice in integration engineering, using insight and evidence to evolve the organisation's integration roadmap
Essential Skills - What You'll Bring
• Significant experience in integration engineering.
• Strong hands-on expertise with the Boomi Integration Platform, including process design, orchestration, integration development, API exposure, and enterprise deployment patterns.
• Proven experience designing scalable enterprise integration architectures across cloud services, SaaS platforms, enterprise applications and APIs.
• Experience delivering complex multi-s...
....Read more...
Type: Permanent Location: Cheyenne, US-WY
Salary / Rate: Not Specified
Posted: 2026-08-19 10:05:54
-
Key Responsibilities
• Act as the principal technical authority for integration engineering across Maximus UK, providing deep leadership across Boomi-based integration solutions.
• Define and maintain integration engineering standards, patterns, guardrails, and best practices for system-to-system integrations, APIs, events, and workflows.
• Provide hands-on technical leadership for the design and implementation of complex integrations built on Boomi and related integration technologies.
• Design scalable integration architectures connecting cloud services, SaaS platforms, enterprise applications and data platforms.
• Drive adoption of modern integration patterns, including API-first design, event-driven architectures, microservices-aligned integrations, and reusable integration components.
• Guide the team's technical direction, improve engineering quality, and support consistent delivery standards.
• Lead technical discovery sessions, design workshops, and integration architecture discussions with business stakeholders, architects, product teams, and engineering colleagues.
• Translate business and operational requirements into robust integration designs and implementation plans that balance speed, resilience, supportability, and long-term value.
• Establish governance approaches for integration code quality, peer review, CI/CD, testing, deployment, observability, and operational readiness.
• Ensure integrations are secure by design, with appropriate controls for authentication, authorisation, encryption, auditability, and protection of sensitive data including PII and PHI.
• Drive the development of reusable integration components, frameworks, and reference implementations that improve delivery speed, quality, and consistency across projects.
• Mentor and develop integration engineers, raising technical capability, architectural understanding, and engineering discipline across the integration team.
• Evaluate opportunities to simplify the integration and automation estate, reduce platform dependency, and introduce more cost-effective and flexible integration approaches.
• Collaborate with automation specialists (e.g.
Automation Anywhere engineers) to define clear boundaries between integration and automation layers and ensure coherent end-to-end designs.
• Monitor technology trends, platform capabilities, and industry best practice in integration engineering, using insight and evidence to evolve the organisation's integration roadmap
Essential Skills - What You'll Bring
• Significant experience in integration engineering.
• Strong hands-on expertise with the Boomi Integration Platform, including process design, orchestration, integration development, API exposure, and enterprise deployment patterns.
• Proven experience designing scalable enterprise integration architectures across cloud services, SaaS platforms, enterprise applications and APIs.
• Experience delivering complex multi-s...
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Type: Permanent Location: Rock Springs, US-WY
Salary / Rate: Not Specified
Posted: 2026-08-19 10:05:54
