Coordinator 2 - Appeals

Description & Requirements

Maximus is currently hiring for Coordinator 2 - Appeals to join our QIC Part C team. This is a remote opportunity. The Coordinator 2 is responsible for reviewing Medicare Part C appeals which includes researching rules and regulations, setting up medical reviews, writing decision letters, among other tasks.

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:

Function as a Subject Matter Expert in one or more process areas.

- Analyze data submitted for Independent Medical Review.

- Conduct fact finding and analyses on those cases deemed complex in nature or requiring adjudication; apply established procedures where the nature of the system, feasibility, computer equipment and reporting tools have not already been decided.

- Track and meet required deadlines for complex cases or other assigned tasks.

- Assist leadership through research of data and/or authoring reports.

- Analyze data using all applicable state law, state regulations, process documents, and other sources as defined by the client contract.

- Work independently on specific situations or on a team to resolve problems and deviations according to current established practices; and obtains advice where precedents are unclear or not available from the client.

- Answer and respond to phone calls/emails from participants in the Independent Medical Review process.

- Assist others or provide on-the-job training or act as a mentor to production staff.

Minimum Requirements

- High School Degree or equivalent required.

- 2-4 years of related professional experience required.

- 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 internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.

Accommodations
Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at applicantaccom@maximus.com.

Minimum Salary

$

20.50

Maximum Salary

$

20.50

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