Sr Specialist - QA - Maximus

Maximus is currently hiring for a Sr Specialist - QA to join our State East team. This is a remote opportunity. The Sr. Specialist - QA is responsible for reviewing cases, providing feedback to appeals officers, and making corrections as needed within the required deadlines.

Essential Duties and Responsibilities:

- Drive a data culture, operate as a site data expert/champion

- Use data to select and drive initiatives and improvements

- Analyze, measure, interpret and deliver site level performance data to Operations.

- Collaborate with cross-functional partners to develop initiatives to improve site performance

- Identify and work to resolve content and/or process discrepancies; identify additional training needs and present to internal partners.

- Build relationships with and collaborate with other subject matter experts; possibly including the customer; content developers; and policy experts.

- Support the Contact Center by staying up to date with processes and initiatives

- Ensure CSRs have what they need to provide world class customer service

- Be present be available, proactive and responsive, act as a voice to/of the CSR

- Possess familiarity and understanding of CMS processes, methodology, and applicable content

- Other duties as assigned

- Monitors and manages QC case load including standard and expedited cases to ensure timely submissions and meet client deadlines

- Review and analyze medical records and health plan documentation to identify issue/concern

- Review determination letters to identify both low level and high-level errors and ensure well documented and accurate outcomes

- Communicate findings with Management, Appeals Officers, Preliminary Review Department and/or Administrative Team

- Maintains knowledge of rules and regulations, policies, procedures, and specific client requirements

- Bachelor's degree in relevant field of study and 5+ years of relevant professional experience required, or equivalent combination of education and experience.

- Ability to commit to a training schedule of 8am-5pm CST Monday - Friday required

- Ability to work occasional weekends as necessary required

- Technical writing and/or technical editing experience in a medical setting highly preferred

- Knowledge of medical terminology preferred

- Knowledge of medical appeals preferred

- Must be a self-starter

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

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.

Annual Base Pay Minimum for this Position

$

53,500.00

Annual Base Pay Maximum for this Position

$

67,000.00