This position involves data verification and input using health plan case files and data systems to evaluate Part C appeals.

Job Summary

Essential Duties and Responsibilities:
• Reviews case file documentation to determine appeal issues and evaluate health plan decisions
• Applies Medicare rules and health plan contract information; performs letter-writing to complete basic adjudication of cases
• Requests additional information from Medicare health plans as appropriate
• Accurately updates the QICtrk system and/or MAS, and reviews data from other databases including ELMO.
• Assists other team members in maintaining, collecting sensitive case documents.
• Escalates potential Privacy issues to the appropriate department
• Follows policies and procedures without deviation
• Tracks and meets required deadlines for cases or other assigned tasks, working independently on specific situations or on a team to resolve problems and deviations according to current established practices; and obtains advice where precedents are unclear or not available from the client.
• Assists supervisor with special projects and tasks on an as needed basis
• Perform other duties as may be assigned by management.

Education and Experience:
• High School Diploma with 2-4 years of experience.
• May have additional training or education in area of specialization.
• Works on assignments that are semi-routine in nature but recognizes the need for occasional deviation from accepted practice.
• Communicates more complex information, using job experience to anticipate and proactively address related questions.

MAXIMUS Introduction

Since 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.

EEO Statement

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.

Posted Max

USD $24.04/Hr.

Posted Min

USD $14.13/Hr.

Salary: $19.00