Appeals Clerk

Description & Requirements

Maximus is currently hiring for Appeals Clerks to join our EAOS team.

This is a hybrid opportunity, requiring you to work onsite in Jenkins Township, PA for the first four-weeks of training before the role becomes fully remote.

This role begins Monday, August 4th, 2025.

The Appeals Clerk is responsible for providing administrative support for the Eligibility Appeals Operations Support (EAOS) Project.

Essential Duties and Responsibilities:
- Analyze appeals data using federal and/or state laws and regulations, along with technical direction, guidance, tools, and standard operating procedures provided by the project or client.

Detect and correct any errors found.
- Issue informal resolution based on review of an appeal case by obtaining information from various resources.
- Conformance with requirements and technical soundness of completed work are reviewed by the supervisor, or are controlled by mechanisms built into the appeals processes.

- Issue informal resolution based on review of an appeal case by obtaining information from various resources, including utilization of the Income Verification Tool/calculator.

- Analyze appeals data using federal and/or state laws and regulations along with technical direction, guidance, tools and standard operating procedures provided by unit or client.

- Contact the appellant for more information and to clarify questions.

- Find any errors during completion of template and correct errors to ensure timely processing Provide telephone outreach to the appellants to explain the results of the IR determination and respond to inquiries based on the standard procedure/process.

- Initiate and terminate pended benefits coverage to determine the appellant's eligibility during the adjudication of the appeal.

- Utilize the Marketplace Change Utility to update appellant applications using information and documentation collected during the appeal process.

- Use specialized tools for complex effectuation scenarios to ensure proper allocation of subsidies.

- Perform other functions as requested by management within scope of level or provide occasional support of lower level functions as business and volume needs require.

Minimum Requirements

- High School diploma or equivalent required.
- At least two (2) years of related experience required.
- Associate degree from an accredited college or university preferred.
- May have additional training or education in area of specialization.

- Associate's Degree from an accredited college or university or equivalent experience required Bachelor's Degree from an accredited college or university in business or related field preferred.

- At least two (2) years of related experience required.

- More than two (2) years of experience in healthcare or appeals preferred.

- Strong attention to details and proven ability to determine course of action based on multiple sources of information.

- Intermediate to advanced skill level in use of personal...