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Maximus
Maximus
ConsultingGovernmentHealthcare
Maximus helps government agencies deliver and modernize essential public programs across healthcare, human services, defense, national security, and civilian services. Its work spans AI and analytics, cloud and cybersecurity, digital platforms, contact centers, eligibility and enrollment systems, clinical services, Medicaid enterprise solutions, consulting, and program operations. With teams supporting federal, state, and local clients, Maximus combines technology with hands-on delivery to improve how people access public services and how agencies achieve their goals.
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Senior Appeals Administrator – California Remote

Maximus is hiring a Senior Appeals Administrator to process California workers’ compensation medical review appeals remotely. The role involves analyzing healthcare records, maintaining case data, and supporting stakeholders throughout the appeals process.

USUnited StatesCACalifornia
$24 / hour
RemoteFull-timeSeniorEnglish RequiredAdministration

Description

  • Stay current on project and corporate policies and procedures
  • Serve as a subject matter expert in one or more process areas
  • Review and analyze data submitted for Independent Medical Review
  • Gather and assess reports from treatment providers, facilities, participants, laboratories, and health plans
  • Record required information accurately in the case management system
  • Handle calls from clients, health plans, providers, and enrollees about case status, program questions, and the appeals process
  • Work within established guidelines while taking initiative to meet objectives and deadlines

Requirements

  • Associate degree and at least two years of experience
  • A high school diploma or GED with at least four years of experience may substitute for an associate degree
  • At least two years of experience in healthcare, medical office administration, or a related field
  • Proficiency with computers and daily use of web-based applications
  • Strong analytical abilities
  • Detail-oriented and solution-focused approach
  • Excellent written and verbal communication skills
  • Knowledge of medical terminology
  • Experience accurately reviewing and processing medical records or other healthcare documentation
  • Ability to work independently
  • Private and secure workspace
  • Reliable high-speed internet with at least 20 Mbps download and 5 Mbps upload, or 50 Mbps download for shared connectivity

Benefits

  • Flexible work schedule
  • Medical, dental, vision, and life insurance coverage
  • Discounts on auto, home, renters, and pet insurance
  • 401(k) retirement plan with company matching
  • Paid time off, holidays, and extended sick leave
  • Short- and long-term disability coverage
  • Employee Assistance Program offering physical, emotional, and financial wellness resources
  • Employee recognition platform
  • Diversity, equity, and inclusion initiatives
  • Tuition reimbursement
  • Employee discounts and perks
  • Maximus Wellness Program and related resources
  • Professional development through training, workshops, and conferences
  • Company-provided computer equipment
  • Comprehensive training
  • Private and secure workspace requirements
  • Reliable high-speed internet service

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USUnited StatesALAlabamaAZArizonaFLFloridaIDIdahoKSKansasMEMaineMIMichiganMSMississippiMOMissouriNMNew MexicoNCNorth CarolinaOKOklahomaPAPennsylvaniaSCSouth CarolinaTNTennesseeTXTexasVAVirginiaWVWest VirginiaWIWisconsinRemoteFull-timeJuniorMiddleEnglish RequiredRecruitment

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Open