Maximus is currently hiring for a Manager - Arbitration Operations to join our State East Arbitration team. This is a remote opportunity. The Manager is responsible for overseeing the day-to-day administration and performance of a state-sponsored surprise billing dispute resolution program. This role leads operational teams that facilitate independent dispute resolution (IDR) and arbitration processes between healthcare providers, health plans, and other stakeholders. The Manager ensures compliance with state regulations, contract requirements, service-level agreements (SLAs), and quality standards while driving operational excellence and stakeholder satisfaction.
The ideal candidate possesses strong healthcare regulatory knowledge, arbitration/dispute resolution experience, leadership capabilities, and a proven track record managing high-volume operations.
Essential Duties and Responsibilities:
Manage assigned teams and staff.
Develop, monitor, and use quality control procedures and audit criteria to ensure consistent application of contractual requirements and established policies and procedures.
Frequent interaction with subordinate employees, customers, and/or functional peer group managers, normally involving matters between functional areas, other company divisions or units, or customers and the company.
Provide guidance to subordinates within the latitude of established company policies.
Recommend changes to policies and establish procedures that affect immediate organization(s).
Perform other duties as assigned by management.
'- Ability to perform comfortably in a fast-paced, deadline-orientated work environment.
Excellent organizational, interpersonal, written, and communication skills.
Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products.
Develop and analyze operational reports, dashboards, and key performance indicators.
Monitor program performance against contractual SLAs and performance guarantees.
Perform other duties as assigned by management.
Operational Leadership:
Manage daily operations of the surprise billing arbitration program, ensuring timely and accurate case processing.
Lead, coach, and develop a team of supervisors, analysts, coordinators, and arbitration specialists.
Monitor workloads, staffing levels, productivity, and quality performance metrics.
Establish and implement operational procedures, workflows, and best practices.
Identify process improvement opportunities and implement solutions to increase efficiency and compliance.
Program Administration:
Oversee intake, review, assignment, tracking, and resolution of arbitration cases.
Manage assigned staff.
Provide guidance to subordinates within the latitude of established company policies.
Recommend changes to policies and establish procedures that affect immediate organization(s).
Ensure cases are managed in accordance with applicable state laws, regulations, policies, and contractual requirements.
Maintain comprehensive documentation and case management protocols.
Coordinate with arbitrators, providers, health plans, and regulatory agencies throughout the dispute resolution process.
Compliance & Quality Assurance:
Ensure adherence to state surprise billing regulations, privacy requirements, and program standards.
Monitor quality assurance activities and implement corrective action plans when needed.
Conduct audits and reviews to ensure consistency and accuracy in program administration.
Support regulatory reporting and compliance monitoring activities.
Client & Stakeholder Management:
Serve as a primary operational contact for state agency representatives and key stakeholders.
Facilitate meetings, program reviews, and performance discussions.
Resolve escalated issues and stakeholder concerns in a timely and professional manner.
Foster collaborative relationships with healthcare providers, payers, legal representatives, and dispute resolution entities.
Performance Management & Reporting:
Develop and analyze operational reports, dashboards, and key performance indicators.
Monitor program performance against contractual SLAs and performance guarantees.
Present performance results, trends, risks, and recommendations to senior leadership.
Support forecasting, capacity planning, and resource management activities.
Minimum Requirements
'- Bachelor's degree in relevant field of study and 5+ years of relevant professional experience required, or equivalent combination of education and experience.
Familiarity with Appeals & Hearings is required. Expertise within the Hearings & Appeals function is strongly preferred.
'- Experience administering surprise billing, independent dispute resolution (IDR), arbitration, or healthcare appeals programs.
Experience managing client-facing operations and performance metrics.
Strong understanding of healthcare reimbursement, claims processing, or payer-provider relations.
Demonstrated experience with process improvement and operational oversight.
Knowledge of and experience working with explanation of benefits and claim forms.
Experience in matters related to healthcare billing and healthcare reimbursement.
Ability to work a schedule between the hours of 8:00am - 6:00pm EST Monday - Friday.
Preferred Qualifications:
Knowledge of state and federal surprise billing regulations.
Experience working within government contracts or regulatory environments.
Knowledge of state and federal surprise billing regulations.
Experience working within government contracts or regulatory environments.
Experience working with the FAIR Health platform and/or All-Payer Claims Database.
Knowledge, Skills, and Abilities:
Strong leadership, coaching, and team development skills.
Excellent analytical and problem-solving abilities.
Ability to interpret regulations, policies, and contractual requirements.
Strong organizational and project management skills.
Excellent written, verbal, and presentation communication skills.
Proficiency with case management systems, reporting tools, and Microsoft Office applications.
Ability to manage multiple priorities in a fast-paced, deadline-driven environment.
Key Performance Metrics:
Case processing timeliness and backlog management.
Compliance with state regulatory requirements.
SLA achievement and contract performance.
Quality assurance and accuracy rates.
Stakeholder satisfaction scores.
Employee engagement and retention.
Continuous improvement and operational efficiency outcomes.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
Internet speed of 25mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
Minimum 5mpbs upload speed
Connectivity to the internet via Category 5 or 6 ethernet patch cable to the home router
Private and secure work area and adequate power source
Must currently and permanently reside in the Continental US
Must have a smartphone which will be required to log into Maximus systems
Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Minimum Salary
$80,000
Maximum Salary
$90,000
