Senior Administrator – Appeals
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Job Description
Senior Administrator processing California workers' compensation medical review appeals for Maximus. Analyzing healthcare documentation, entering case data, and answering stakeholder questions remotely.
Responsibilities:
- Maintain updated knowledge of project and corporate policies and procedures
- 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
- Enter necessary information into the system
- Respond to incoming calls from clients, health plans, providers, and enrollees regarding case status, program questions, and the appeals process
- Follow established guidelines and directions while proactively meeting objectives and deadlines
Requirements:
- Associate degree with 2+ years' experience
- Experience in lieu of an Associate degree also considered: HS Diploma or GED and 4+ years of experience
- 2 years' experience in healthcare, medical office administration, or a related field
- Proficient in computer usage, including daily operation of web-based applications
- 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
- Ability to work independently
- Must maintain a private and secure workspace
- Reliable high-speed internet: minimum 20 Mbps download/50 Mbps for shared internet connectivity and minimum 5 Mbps upload
Benefits:
- Flexible schedule
- Comprehensive medical, dental, vision, and life insurance
- Discounts on auto, home, renter's, and pet insurance
- 401K retirement savings plan with company matching
- Paid time off, holidays, and extended sick leave
- Short-term and long-term disability coverage
- Employee Assistance Program (EAP) with physical, emotional, and financial wellness resources
- Recognition platform
- Diversity, Equity, and Inclusion initiatives
- Tuition reimbursement
- Employee perks and discounts
- Maximus Wellness Program and resources
- Professional development opportunities, including training programs, workshops, and conferences
- Company-issued computer equipment
- Comprehensive training
- Private and secure workspace requirements
- Reliable high-speed internet service
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