Maximus

Essential Duties and Responsibilities:
- Respond to exemption and exclusion, good cause, FIDA and MLTC service calls; provides responses to questions; mails information in response to requests, and refers callers to the appropriate agency for resolution.
- Assess consumers’ health care needs and assists consumers in choosing a health plan.
- Maintain updated knowledge of the client contract program.
- Assist consumers in enrolling/disenrolling from health plans.
- Receives and sorts exemption and exclusion, good cause, MLTC, FIDA and expedited forms.
- Review exemption and exclusion forms for completeness and accuracy.
- Processes exemption and exclusion, good cause, MLTC, FIDA and expedited forms.
- Sends necessary letters to consumers.
- Raises issues of concern and/or problems to the attention of the Case Management Supervisor.
- Perform managed care education and enrollment services when call volume warrants.
- Assist supervisor in meetings, keeping Case Management CSRs current with updated policies and procedures.
- Maintains control log on Exemption and Exclusion processing and provides log to backup unit for callback purposes.
- Checks MAXeb for all dispositions daily and maintains exemption status report log.
- Research and follows up on problematic cases.
- Review updated procedures for supervisor’s final review.
- Maintain updated memos and information.
- Assist Case Management CSRs with difficult calls and provides additional training based on identified weaknesses.
- Assist Case Management CSRs with forms processing.
- Evaluates daily ACD reports as to individual Case Management CSR performance and report’s findings to Case Management Supervisor.
- Provide program training to Case Management CSRs.
- Some Saturday work required.
- Meet all standards established for this position as outlined in the corresponding annual performance criteria and bonus template for this position.
- Perform other duties as may be assigned by the Case Management Supervisor or other project management.

- High school diploma or GED required and 1.5+ years of relevant professional experience required, or equivalent combination of education and experience.

- Assist supervisor/manager with the management of daily activities over a group of agents that handle customer service inquiries and problems via the telephone and sometimes email.
- Provide direction and guidance to less experienced team members and provides coaching on how to handle more complex inquiries.
- Recognizes and recommend areas needing improvement.
- May assist in scheduling and coordinating team activities.
- May provide input into hiring decisions and performance appraisals, but does not necessarily make hiring decisions or conduct performance appraisals.
- Work on a variety of assignments requiring considerable judgement and initiative.
- Able to draft or modify training materials and procedural documentation accurately.
- Skilled in handling challenging communications with external contacts for escalated matters.

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.

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.