Senior Appeals Administrator (US Remote)

Maximus is hiring Senior Appeals Administrators for the California Independent Medical Review (CA IMR) team.

In this role, you'll play a critical role in ensuring fair and timely resolutions for medical review cases. Your expertise will strengthen our appeals process and directly impact the quality of care for those we serve.

What You'll Do

• Stay up to date on company and project- specific policies and procedures.
• Serve as a subject matter expert for one or more appeals process areas.
• Review and analyze data for Independent Medical Reviews (IMR).
• Collect, verify, and enter case data from providers, facilities, and health plans.

Why Maximus?

• Work/Life Balance Support - Flexibility tailored to your needs!
• Competitive Compensation - Bonuses based on performance included!
• Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, Vision, Prescription, and partially funded HSA. Additionally, enjoy Life insurance benefits and discounts on Auto, Home, Renter's, and Pet insurance.
• Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching.
• Paid Time Off Package - Enjoy PTO, Holidays, and extended sick leave, along with Short- and Long-Term Disability coverage.
• Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP).
• Recognition Platform - Acknowledge and appreciate outstanding employee contributions.
• Tuition Reimbursement - Invest in your ongoing education and development.
• Employee Perks and Discounts - Additional benefits and discounts exclusively for employees.
• Maximus Wellness Program and Resources - Access a range of wellness programs and resources tailored to your needs.
• Professional Development Opportunities - Participate in training programs, workshops, and conferences.

Essential Duties and Responsibilities

• Maintain updated knowledge of project and corporate policies and procedures as referenced in the employee manual and other desk procedures for the position.
• Function as a Subject Matter Expert in one or more process areas.
• Analyze data submitted for Independent Medical Review.
• Collect and analyze incoming data and reports from treatment providers, facilities, participants, labs and health plans to input necessary information into the system.
• Respond to incoming calls from clients, health plans, providers and enrollees regarding case status, questions about the program, and the appeals process.

Minimum Requirements

• Associate degree with 2 years experience.
• Experience in lieu of an Associate degree (HS Diploma or GED and 4 years of experience) also considered.
• At least 2 years of data entry experience.
• Experience working with MS office applications (Excel, Word, etc.).
• Excellent organizational, interpersonal and verbal communication skills.
• Ability to work independently and collaboratively in a remote, fast-paced environment.

Preferred Requirements

• Experience using medical terminology in a professional setting.

Home Office Requirements

• Maximus provides company-issued computer equipment.
• Reliable high-speed internet service.
• Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity.
• Minimum 5 Mpbs upload speeds.

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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: $24 Maximum Salary: $24