Team Leader - Medical (Remote)

Description & Requirements

Maximus is currently hiring a Team Leader - Medical to support the Independent Medical Review (IMR) and Independent Billing Review (IBR) programs.

In this role, you will oversee complex case management, ensure compliance with contract regulations, and serve as a subject matter expert in IMR and IBR processes.

You will collaborate with Claims Administrators, the CA Division of Workers' Compensation (DWC), and internal teams to manage appeals, eligibility determinations, and procedural enhancements.

This position requires strong analytical skills, excellent communication, and leadership abilities to drive operational excellence.

What You Will Receive:


* Work/Life Balance Support - Flexible work arrangements tailored to your needs!


* • Competitive Compensation - Performance-based bonuses included!


* • Comprehensive Insurance Coverage - Medical, Dental, Vision, Prescription, HSA, Life Insurance, and discounts on Auto, Home, Renter's, and Pet Insurance.


* • Future Planning - 401K Retirement Savings plan with Company Matching.


* • Paid Time Off Package - PTO, Holidays, Extended Sick Leave, and Short/Long-Term Disability coverage.


* • Holistic Wellness Support - Employee Assistance Program (EAP) for physical, emotional, and financial well-being.


* • Recognition Platform - Celebrate outstanding employee contributions.


* • Diversity, Equity, and Inclusion Initiatives - A workplace committed to fostering diversity and inclusion.


* • Tuition Reimbursement - Invest in your ongoing education and professional growth.


* • Employee Perks and Discounts - Exclusive benefits and discounts for employees.


* • Maximus Wellness Program & Resources - Access a variety of wellness programs designed for your needs.


* • Professional Development Opportunities - Participate in training programs, workshops, and conferences.

If you are an organized, detail-oriented professional with expertise in medical review and billing processes, we encourage you to apply and make an impact at Maximus!

Essential Duties and Responsibilities:
- Monitor the performance of, manage workloads of and perform case assignment for a team of Coordinators and assist with training and staff hiring.
- Develop and maintain processes and procedures at the direction of the director, liaison with Project Directors regarding procedural issues, and communicate with the CA Division of Workers' Compensation (DWC) regarding policy and eligibility issues.
- Manage complex case files from the date received to date closed for Independent Billing Review (IBR) and determine eligibility of CA IBR appeals.
- Respond to requests from Billing for additional information from Claims Administrators as needed.
- Manage complex case files from date received to date closed.
- Determine eligibility of appeals and submit potentially ineligible cases to the CA DWC for final eligibility determination.
- Request additio...