Senior Administrator - Appeals (Remote)

Maximus; City of Albany (NY); Remote; USD 27,000 - 39,000; Full time

Benefits offered by this job

Health insurance

401K plan with company match

Paid time off

Work from home equipment provided

Wellness and Employee Assistance

Job summary

Maximus is hiring for a Senior Administrator - Appeals to support California Independent Medical Review (CA IMR) operations. This fully remote role emphasizes data analysis, verification of medical documentation, and processing of workers' compensation appeals with a collaborative team.

The position includes comprehensive benefits, flexible scheduling, equipment provided by Maximus, and opportunities for professional development in a supportive environment.

Qualifications

• Minimum: Associate degree with 2 years’ experience, or HS Diploma/GED plus 4 years in healthcare/medical admin.
• Proficient with web-based apps and basic computer usage.
• 2 years healthcare/medical office admin or related field preferred.

Responsibilities

• Analyze data submitted for Independent Medical Review.
• Collect and analyze data from treatment providers, facilities, participants, labs, and health plans.
• Input information into the system accurately.
• Respond to calls from clients, health plans, providers, and enrollees regarding case status and the appeals process.
• Maintain updated knowledge of project policies and procedures.

Skills

Strong analytical skills

Detail oriented

Excellent written and verbal comms

Knowledge of medical terminology

Healthcare documentation review

Education

Associate degree with 2 years experience

HS Diploma or GED + 4 years experience

Job description

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.

At Maximus, we are committed to cultivating a positive and inclusive work environment, and we are pleased to offer the following:

• 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.

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.

'- Follows established guidelines and directions while maintaining a proactive approach to meeting objectives and deadlines

• Ability to work independently

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.
• '- Proficient in computer usage, including daily operation of web-based applications
• 2 years experience in healthcare, medical office administration, or a related field.

Preferred Skills

• 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

Home Office Requirements

• 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

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.

Minimum Salary

$24

Maximum Salary

$24