Admin 2 - Appeals

MAXIMUS • Trenton, NJ • 1h ago

Maximus is currently seeking an Admin 2 - Appeals to join our State West team. This is a remote opportunity. This Admin provides administrative and case management support by maintaining accurate case records, processing incoming documentation, entering and validating data, and ensuring timely reporting and case tracking. The position also serves as a point of contact for case status inquiries, supports client reporting requirements, and performs quality audits to ensure compliance with established procedures.

This is a client-facing position and will require a client-specific clearance to include fingerprinting.

Essential Duties and Responsibilities:

Type/generate letters and other documents, as necessary.

Assist in the preparation of reports.

Create files in case management system.

Update status of case in case management system.

Fax and email file determination letters to interested parties.

Collect and analyze incoming data and reports from treatment providers, facilities, participants, labs and health plans to input necessary information into the system.

Respond to incoming calls from clients, health plans, providers and enrollees regarding case status, questions about the program, and the appeals process.

Perform research into invoicing issues and perform outreach to health plans regarding any unpaid invoices.

'- Enter appropriate data into computer systems.

Aid team members with case file maintenance.

Enter appropriate information into automated systems for the tracking of all cases processed.

Receive, process, and distribute incoming mail and faxes.

Produce and maintain data reports and alert management of inconsistencies or issues.

Serves as a point of contact for external inquiries from clients, enrollees, and health plans regarding case status.

Prepare and disseminate case summaries to satisfy client reporting requirements.

Validate application information against documents.

Perform other duties as may be assigned by management.

Perform audits of own work to ensure conformance with established procedures.

Minimum Requirements

'- High School diploma, GED, or equivalent required.

2-4 years of experience required.

'- 2-3 Years of applicable related job experience.

Proficiency in Microsoft Suite, Adobe, and ability to accurately perform data entry.

Excellent organizational, written, and verbal communication skills.

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

Ability to successfully execute complex tasks simultaneously with attention to detail.

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

Ability to work under standards-based performance measures.

Ability to apply critical thinking skills.

Ability to maintain confidentiality and security of all information processed.

Ability to @type 40 WPM.

Familiarity with virtual machines to access external networks.

Ability to work a schedule between the hours of 8:00am - 5:00pm PST Monday - Friday.

Preferred Skills an Qualifications:

Associate's Degree.

Resident of the state of California.

Prior experience working with sensitive information to include protected data.

Prior experience requesting medical records and processing documentation revisions per client request.

Please note: For this position Maximus will provide equipment to use.

Home Office Requirements:

Internet speed of 25mbps 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 Category 5 or 6 ethernet patch cable to the home router

Private and secure work area and adequate power source

Must currently and permanently reside in the Continental US

Must have a smartphone which will be required to log into Maximus systems

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.

Minimum Salary

$21

Maximum Salary

$21

MAXIMUS

Go to Apply

Share this job

Similar Jobs

Operations Group Manager Senior - International Trade Product Delivery (ITPD)

PNC • East Brunswick, NJ • 54min ago

Retail & Hospitality

Home Location-PA (PAH01) Gest Street Cincinnati (OH939) Denver - 12345 W Colfax (CO147) Home Location-OH (OHH01) Dallas Innovation Center - Luna Rd (TX270) Home Location-MI (MIHM1) Home Location-NJ (NJH01) Cleveland Ops...

54min ago

Go to Apply

Senior Attorney, Enterprise Sales

Lumen • Trenton, NJ • 1h ago

Legal & Paralegal

Lumen is the trusted network for the AI-powered world, connecting people, data, and applications through our expansive fiber network and connected ecosystem. We enable secure, high-performance connectivity across cloud,...

1h ago

Go to Apply

Accounts Receivable Specialist

Robert Half • East Brunswick, NJ • 1h ago

Finance, Accounting & Banking

Description We are looking for an Accounts Receivable Specialist in the Middlesex County, NJ area.. TheAR Specialist role will help strengthen collections performance, resolve account issues efficiently, and contribute t...

1h ago

Go to Apply

Senior Claims Specialist - Cyber/MPL/Media

Axis • Princeton, NJ • 1h ago

Finance, Accounting & Banking

New York, NY Chicago, IL Stamford, CT Red Bank, New Jersey Alpharetta, GA Princeton, NJ Short Hills, NJ Full time REQ06740 This is your opportunity to join AXIS Capital - a trusted global provider of specialty lines insu...

1h ago

Go to Apply

Associate Partner Consulting, AI Leader Banking

Cognizant • Princeton, NJ • 1h ago

Finance, Accounting & Banking

About Cognizant Consulting Cognizant Consulting is more than Cognizant's consulting practice. We are a global community of 5,000+ experts dedicated to helping clients reimagine their business. Blending deep industry expe...

1h ago

Go to Apply

Warehouse Supervisor

ManpowerGroup • Bristol, PA • 1h ago

Manufacturing & Warehouse

Warehouse Operations Supervisor Job Summary We are seeking a motivated and people-focused Warehouse Operations Supervisor to lead a dynamic team of 15 to 20 order and material handlers in a fast-paced distribution enviro...

1h ago

Go to Apply

Administrative Assistant

Robert Half • Trenton, NJ • 1h ago

Management & Administrative

Description Our client is seeking an Administrative Assistant to support senior leadership and provide exceptional service to clients. This role combines administrative support, client communication, scheduling, document...

1h ago

Go to Apply

Administrative Assistant

Robert Half • Trenton, NJ • 1h ago

Management & Administrative

1h ago

Go to Apply

Light Industrial Production Line Worker/Picker Packer - 3rd shift (11:15 PM-7:15 AM)

ManpowerGroup • Hillsborough, NJ • 3h ago

Legal & Paralegal

Light Industrial Production Line Worker/Picker Packer Location - Hillsborough, NJ Hours - 11:15pm-7:15am Pay - $17.77/hr Overtime available but not mandatory This position will be working on the production lines, keeping...

3h ago

Go to Apply

medical assistant

Vantage Oncology Centers of Pennsylvania • Doylestown, PA • 5h ago

Hospital & Medical

Overview Alliance Cancer Specialists is seeking a Medical Assistant for our Sellersville/Doylestown Practicesto join our dedicated team in delivering compassionate, high-quality care to oncology patients. This role assis...

5h ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)