Sr Admin - Appeals

Description & Requirements

Maximus is currently hiring for a Sr.

Admin - Appeals to join our QIC Part C team.

This is a remote opportunity.

The Sr.

Admin is responsible for reviewing appeals from Medicare enrollee's with a Part C plan and working the appeal from start to finish.

This includes reviewing requests and provided information, reaching out for additional information when needed, and at its conclusion, writing and uploading a decision letter.

The Sr.

Admin will specifically handle lock-in and cost sharing cases.

This position will require a federal suitability clearance post-hire as mandated by the client.

This clearance is required in order to access client-specific systems as needed to complete the job duties.

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.

- Ability to commit to a 2 week training schedule of 8:30am - 5:00pm EST Monday - Friday required.

Please note: This position requires the use of your personal device for the duration of training.

After training, equipment will be provided.

Home Office Requirements:

- Internet speed of 25mbps 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 Category 5 or 6 ethernet patch cable to the home router

- Personal computer or laptop (Chromebooks, tablets, and notebooks are not allowed) with one of the following operating systems: Windows: 10 or 11 or Mac: Big Sur (11.0.1+), Catalina (10.15), or Monterey (12.3)

- Private and secure work area and adequate power source

- Must currently and permanently reside in the Continental US

EEO Statement

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.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as...