Senior Administrator - Appeals (Remote)

Maximus

4d•Remote

About The Position

Join our California Independent Medical Review (CA IMR) team as a Senior Administrator - Appeals, supporting the review and processing of workers' compensation appeal cases. In this fast-paced, production-driven role, you will analyze and enter medical case information, review documentation for accuracy and completeness, and support the independent medical review process. This fully remote position offers a flexible schedule, comprehensive training, company-provided equipment, and the opportunity to work with a collaborative team dedicated to helping employees succeed.

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.
Proficient in computer usage, including daily operation of web-based applications
2 years experience in healthcare, medical office administration, or a related field.
Maximus provides company-issued computer equipment
Private and secure workspace
Reliable high-speed internet service
Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity
Minimum 5 Mpbs upload speeds

Nice To Haves

Strong analytical skills
Detail and solution oriented
Excellent written and verbal communication
Knowledge of medical terminology
Experience reviewing and processing medical records or other healthcare documentation with a high degree of accuracy and attention to detail.
Follows established guidelines and directions while maintaining a proactive approach to meeting objectives and deadlines

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.
Follows established guidelines and directions while maintaining a proactive approach to meeting objectives and deadlines
Ability to work independently

Benefits

Work/Life Balance Support – Flexibility tailored to your needs!
Comprehensive Insurance Coverage – Medical, Dental, Vision, Life insurance, and enjoy discounts on Auto, Home, Renter's, and Pet insurance.
Future Planning – Prepare for retirement with our 401K Retirement Savings plan and Company Matching.
Paid Time Off Package – Enjoy PTO, Holidays, and extended sick leave, along with Short and Long Term Disability coverage.
Holistic Wellness Support – Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP).
Recognition Platform – Acknowledge and appreciate outstanding employee contributions.
Diversity, Equity, and Inclusion Initiatives – Join a workplace committed to fostering diversity and inclusion.
Tuition Reimbursement – Invest in your ongoing education and development.
Employee Perks and Discounts – Additional benefits and discounts exclusively for employees.
Maximus Wellness Program and Resources – Access a range of wellness programs and resources tailored to your needs.
Professional Development Opportunities: Participate in training programs, workshops, and conferences.