Coordinator I – Medical Arbitration

Remote Opportunity

Our client, , is seeking a Coordinator I – Medical Arbitration to support their Georgia Arbitration team. This position is ideal for a detail-oriented healthcare professional with experience in medical claims, healthcare reimbursement, insurance adjudication, or healthcare compliance.

The successful candidate will review and analyze complex healthcare arbitration cases, evaluate supporting documentation, research applicable regulations, and prepare clear, well-supported determinations. This role requires strong analytical skills, attention to detail, and the ability to work independently in a remote environment.

Responsibilities:

• Review and analyze healthcare arbitration cases involving complex medical claims.
• Evaluate medical claims, Explanation of Benefits (EOBs), remittance advice, provider billing records, and insurance payment calculations.
• Analyze reimbursement methodologies, including contracted rates, median in-network rates, usual and customary charges, and case complexity considerations.
• Review documentation submitted by providers and insurers to identify key facts and determine whether evidence supports each party’s position.
• Apply regulatory requirements and guidelines consistently and objectively.
• Research and interpret Georgia statutes, regulations, guidance documents, and arbitration policies.
• Draft clear, concise, and professional determination letters summarizing case details, evidence reviewed, and decision rationale.
• Maintain accurate case documentation while tracking deadlines and project timelines.
• Collaborate with internal teams and leadership to support arbitration processes and operational goals.

Qualifications:

• Experience with healthcare claims, medical billing, insurance adjudication, healthcare administration, or related fields.
• Strong understanding of healthcare reimbursement processes and claims documentation.
• Ability to analyze detailed information and make objective, well-supported decisions.
• Strong written communication skills with the ability to prepare professional documentation.
• Excellent organizational skills with the ability to manage multiple priorities and deadlines.
• Ability to research and interpret policies, procedures, and regulatory requirements.
• Strong attention to detail and commitment to accuracy.

Preferred Background:

Experience in:

• Healthcare administration
• Medical billing and coding
• Health insurance claims processing
• Healthcare compliance
• Alternative dispute resolution (ADR) or arbitration

Remote Work Requirements:

• Ability to work independently in a fully remote environment.
• Strong time management and organizational skills.
• Effective written and verbal communication skills.
• Experience using virtual collaboration tools such as Microsoft Teams, Outlook, and SharePoint.
• Ability to participate in virtual meetings and training sessions during standard business hours.
• Reliable high-speed internet connection and a dedicated workspace.
• Ability to maintain confidentiality and comply with data security requirements.