Senior Administrator – Appeals

This is a fully remote position, open to applicants in California.

📋 Description

• Keep abreast of project and corporate policies and procedures.

• Serve as a Subject Matter Expert in one or more specific process areas.

• Evaluate data submitted for Independent Medical Review.

• Gather and assess incoming data and reports from treatment providers, facilities, participants, labs, and health plans.

• Input essential information into the system.

• Address incoming inquiries from clients, health plans, providers, and enrollees about case status, program inquiries, and the appeals process.

• Adhere to established guidelines and directions while actively achieving objectives and meeting deadlines.

⛳️ Requirements

• Associate degree with at least 2 years of relevant experience.

• Experience may substitute for an Associate degree: a High School Diploma or GED along with 4+ years of relevant experience.

• A minimum of 2 years’ experience in healthcare, medical office administration, or a related field.

• Proficiency in computer usage, including daily operation of web-based applications.

• Strong analytical capabilities.

• Detail-oriented and solution-focused.

• Exceptional written and verbal communication skills.

• Familiarity with medical terminology.

• Experience in reviewing and processing medical records or other healthcare documentation with a high level of accuracy and attention to detail.

• Capability to work independently.

• Must have a private and secure workspace.

• Dependable high-speed internet: minimum 20 Mbps download/50 Mbps for shared internet connectivity, and a minimum of 5 Mbps upload.

🏝️ Benefits

• Flexible working schedule.

• Comprehensive medical, dental, vision, and life insurance.

• Discounts available for auto, home, renter's, and pet insurance.

• 401K retirement savings plan with company matching contributions.

• Paid time off, holidays, and extended sick leave.

• Coverage for short-term and long-term disability.

• Employee Assistance Program (EAP) offering physical, emotional, and financial wellness resources.

• Recognition platform for employee achievements.

• Initiatives focused on Diversity, Equity, and Inclusion.

• Tuition reimbursement program.

• Employee perks and discounts.

• Maximus Wellness Program and additional resources.

• Opportunities for professional development, including training programs, workshops, and conferences.

• Company-provided computer equipment.

• Comprehensive training provided.

• Requirements for a private and secure workspace.

• Reliable high-speed internet service required.