Senior Administrator - Appeals (Remote)

Maximus; Northern (KY); Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

Work/Life balance

Health insurance

Retirement plan

PTO & disability

EAP

Tuition reimbursement

Wellness program

Employee discounts

Professional development

Job summary

Maximus invites applicants for a Senior Administrator - Appeals on the CA IMR team to support workers' compensation appeal case processing. The role focuses on analyzing and entering medical data, reviewing documentation for accuracy, and supporting the independent medical review workflow in a fast-paced setting.

This remote position offers flexible scheduling, comprehensive training, company-provided equipment, and a collaborative environment dedicated to helping employees succeed.

Qualifications

• Analyze data submitted for Independent Medical Review.
• Input necessary information into the system from treatment providers, facilities, and health plans.
• Respond to calls from clients, health plans, providers, and enrollees about case status and the appeals process.
• Follow guidelines and deadlines with a proactive approach.

Responsibilities

• Maintain updated knowledge of project and corporate policies.
• Serve as SME in one or more process areas.
• Analyze data for IMR accuracy and completeness.

Skills

Analytical skills

Detail-oriented

Medical terminology

Medical records review

Healthcare experience

Education

Associate degree

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
• 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
• 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

• 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

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 [e-mail].