Sr Coordinator - Appeals

MAXIMUS
US - South Dakota - Sioux Falls
November 17, 2024

Description & Requirements

Maximus is currently hiring for a Sr. Coordinator - Appeals to join our Fed NSA team. This is a remote opportunity. The Sr. Coordinator - Appeals is responsible for reviewing payment determinations from the initiating party. The Sr. Coordinator must logically analyze information and apply various factors to an ultimate decision and final payment determination. Impartiality in review is essential.

Essential Duties and Responsibilities:
• Assist leadership through research of data and/or authoring reports.
• Analyze data using all applicable law regulations (state and/or government 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 obtain advice where precedents are unclear or not available from the client.
• Respond to the needs of outside contacts, including but not limited to: Client, injured workers, injured worker's representatives, claims administrators, providers, etc.
• Answer and respond to phone calls/emails within defined timeframes.
• Identify the need for process changes and documentation updates and/or development.
• Create, maintain, and update documentation when appropriate in accordance with document control process.

Minimum Requirements
• High school diploma or GED required and 4+ years of relevant professional experience required, or equivalent combination of education and experience.
• Experience in a healthcare setting and/or with appeals and claims required
• Prior Fed NSA experience preferred
• Ability to commit to a training schedule of 8:30am - 5:00pm EST Monday - Friday required
• Ability to work a schedule between the hours of 7:00am - 6:30pm EST Monday - Friday required

Please note: For this position Maximus will provide equipment to use.

Home Office Requirements:
• Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to speedtest.net)
• Minimum 5mpbs upload speed
• Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
• Private work area and adequate power source
• Must currently and permanently reside in the Continental US

EEO Statement

Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We're proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

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.

Minimum Salary

$

25.00

Maximum Salary

Read the full job description and apply online on the recuiter's web-site

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