Description & Requirements
Maximus is hiring Senior Appeals Administrators for the California Independent Medical Review (CA IMR) team.
In this role, you’ll play a critical role in ensuring fair and timely resolutions for medical review cases. Your expertise will strengthen our appeals process and directly impact the quality of care for those we serve.
What You’ll Do:
- Stay up to date on company and project- specific policies and procedures.
- Serve as a subject matter expert for one or more appeals process areas.
- Review and analyze data for Independent Medical Reviews (IMR).
- Collect, verify, and enter case data from providers, facilities, and health plans.
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.
- Associate degree with 2+ years' experience.
- Experience in lieu of an Associate degree (HS Diploma or GED and 4+ years of experience) also considered.
- Experience working with MS office applications (Excel, Word, etc.)
- Ability to work independently and collaboratively in a remote, fast-paced environment