Appeals Clerk - United States - 30243 - Maximus

General information

Job Posting Title

Appeals Clerk

Date

Wednesday, May 21, 2025

City

Jenkins Township

State

Country

United States

Working time

Full-time

Description & Requirements

Maximus is currently hiring for Appeals Clerks to join our EAOS team. This is a hybrid opportunity, requiring you to work onsite in Jenkins Township, PA for the first four-weeks of training before the role becomes fully remote. This role begins Monday, August 4th, 2025. The Appeals Clerk is responsible for providing administrative support for the Eligibility Appeals Operations Support (EAOS) Project.

Essential Duties and Responsibilities:
- Analyze appeals data using federal and/or state laws and regulations, along with technical direction, guidance, tools, and standard operating procedures provided by the project or client. Detect and correct any errors found.
- Issue informal resolution based on review of an appeal case by obtaining information from various resources.
- Conformance with requirements and technical soundness of completed work are reviewed by the supervisor, or are controlled by mechanisms built into the appeals processes.

- Issue informal resolution based on review of an appeal case by obtaining information from various resources, including utilization of the Income Verification Tool/calculator.

- Analyze appeals data using federal and/or state laws and regulations along with technical direction, guidance, tools and standard operating procedures provided by unit or client.

- Contact the appellant for more information and to clarify questions.

- Find any errors during completion of template and correct errors to ensure timely processing Provide telephone outreach to the appellants to explain the results of the IR determination and respond to inquiries based on the standard procedure/process.

- Initiate and terminate pended benefits coverage to determine the appellant’s eligibility during the adjudication of the appeal.

- Utilize the Marketplace Change Utility to update appellant applications using information and documentation collected during the appeal process.

- Use specialized tools for complex effectuation scenarios to ensure proper allocation of subsidies.

- Perform other functions as requested by management within scope of level or provide occasional support of lower level functions as business and volume needs require.

Minimum Requirements

- High School diploma or equivalent required.
- At least two (2) years of related experience required.
- Associate degree from an accredited college or university preferred.
- May have additional training or education in area of specialization.

- Associate's Degree from an accredited college or university or equivalent experience required Bachelor's Degree from an accredited college or university in business or related field preferred.

- At least two (2) years of related experience required.

- More than two (2) years of experience in healthcare or appeals preferred.

- Strong attention to details and proven ability to determine course of action based on multiple sources of information.

- Intermediate to advanced skill level in use of personal computer and related software applications such as Microsoft Word, Excel or Access.

- Ability to type 35 words per minute accurately.

- Excellent organizational, interpersonal, written and verbal communication skills.

- Ability to perform comfortably in a fast-paced, deadline-oriented work environment.

- Ability to successfully execute tasks simultaneously.

- Ability to work as a team member, as well as independently.

- Ability to commit to a four-week training onsite at the Jenkins Township, PA office, with zero absences, starting 8/4/25 required.

- Ability to commit to a four-week training schedule of 7:30am - 4:00pm EST Monday - Friday required.

- Ability to work a schedule of 7:30am - 4:00pm 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 www.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

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

For positions on this contract, Maximus will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor. That wage rate will vary depending on locality. An applicant's salary history will not be used in determining compensation.