Sr Specialist - QA

Description & Requirements

Maximus is currently hiring for a Sr Specialist - QA to join our State East team.

This is a remote opportunity.

The Sr.

Specialist - QA is responsible for reviewing cases, providing feedback to appeals officers, and making corrections as needed within the required deadlines.

Essential Duties and Responsibilities:

- Drive a data culture, operate as a site data expert/champion

- Use data to select and drive initiatives and improvements

- Analyze, measure, interpret and deliver site level performance data to Operations.

- Collaborate with cross-functional partners to develop initiatives to improve site performance

- Identify and work to resolve content and/or process discrepancies; identify additional training needs and present to internal partners.

- Build relationships with and collaborate with other subject matter experts; possibly including the customer; content developers; and policy experts.

- Support the Contact Center by staying up to date with processes and initiatives

- Ensure CSRs have what they need to provide world class customer service

- Be present be available, proactive and responsive, act as a voice to/of the CSR

- Possess familiarity and understanding of CMS processes, methodology, and applicable content

- Other duties as assigned

- Monitors and manages QC case load including standard and expedited cases to ensure timely submissions and meet client deadlines

- Review and analyze medical records and health plan documentation to identify issue/concern

- Review determination letters to identify both low level and high-level errors and ensure well documented and accurate outcomes

- Communicate findings with Management, Appeals Officers, Preliminary Review Department and/or Administrative Team

- Maintains knowledge of rules and regulations, policies, procedures, and specific client requirements

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.

- Ability to commit to a training schedule of 8am-5pm CST Monday - Friday required

- Ability to work occasional weekends as necessary required

- Technical writing and/or technical editing experience in a medical setting highly preferred

- Knowledge of medical terminology preferred

- Knowledge of medical appeals preferred

- Must be a self-starter

Please note: For this position Maximus will provide equipment to use.

Home Office Requirements:

- Internet speed of 20mbps 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 either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router

- Private work area and adequate power source

- Must currently and permanently reside in the Continental US

EEO Statement

Active military service members, their spouses, and veteran candidates ofte...