Manager - Arbitration Operations

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.
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