Essential Duties and Responsibilities:Stay updated on corporate policies and procedures as outlined in the employee manual and desk procedures relevant to the role.Serve as a Subject Matter Expert in one or more specific process areas.Analyze data submitted for Independent Medical Review.Collect and evaluate incoming data and reports from treatment providers, facilities, and health plans to input essential information into the system.Respond to inquiries from clients, health plans, providers, and enrollees regarding case status and the appeals process.Initiate and manage arbitration cases within the system.Request additional information from providers and health plans as needed.Conclude arbitration cases accurately in the system.Conduct analysis on data received from providers and health plans.Minimum Requirements:Associate degree with over 2 years of relevant experience, or a high school diploma/GED with 4years of experience.Strong organizational skills to efficiently manage multiple tasks and maintain accurate records.Exceptional written and verbal communication skills for effective interaction with healthcare providers and insurance companies.Proficiency in working across various platforms and excellent command of Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and healthcare billing systems.Ability to thrive in a fast-paced, deadline-driven environment with a high level of accuracy in data entry and document management.Capable of working independently and collaboratively within a remote team.Experience with Salesforce preferred.Understanding of healthcare billing, CPT codes, and the No Surprises Act is a plus.Prior experience with healthcare appeals, grievances, and retroactive claim review is highly desirable.Familiarity with insurance documentation, explanation of benefits, and claim forms would be advantageous.Commitment to working hours from 8:00 AM to 5:30 PM EST, Monday to Friday is required.Note: This position provides equipment for remote work.Home Office Requirements:Internet speed of 25mbps or higher is required (50 Mbps for shared connectivity).Minimum upload speed of 5mbps.Connection via Category 5 or 6 ethernet patch cable to the home router.A private and secure work area with adequate power supply.Must permanently reside in the Continental US.EEO Statement:Maximus is an equal opportunity employer evaluating qualified applicants without discrimination based on race, color, religion, sex, age, national origin, disability, veteran status, genetic information, and other legally protected characteristics.Pay Transparency:Maximus compensation is influenced by factors including job location, education, training, experience, and internal alignment, among others. The salary range reflects the position's duties and candidate's relevant experience, with annual salary being part of a comprehensive total compensation package, including various employee benefits.Accommodations:Maximus provides reasonable accommodations for individuals needing assistance during the employment process due to disabilities or medical conditions. Please contact People Operations for assistance with job postings, assessments, or interviews.Salary Range:Minimum:$18.70Maximum:$20.00
Experience: 2 years required