Supervisor - Appeals - Maximus

Maximus is looking to fill a Supervisor - Appeals position. In this role, you will oversee the independent external appeals process by supervising Appeals Officers, providing advice on case issues, and managing your own case load, including reviewing patient records, documenting information, and preparing decision letters or reports using online resources.

Essential Duties and Responsibilities:
- Oversee functions associated with healthcare applications processing, complaints, and appeals.
- Assist management with department/project objectives.
- Provide supervision to assigned staff.
- Responsible for reporting issues, problems and concerns to management.
- Complete daily and weekly reports.
- Compile and analyze daily production statistics.
- Monitor workload and coordinate schedules with Work Force Management.
- Responsible for coaching team, setting expectations, conducting performance appraisals, providing career development, corrective action and recognition for assigned staff.
- Monitor team performance to ensure team/project meets Service Level Agreements.
- Provide staff performance feedback and mentoring to continuously meet and exceed individual goals.
- Evaluate the need for training to ensure specialists maintain current knowledge of multiple programs.
- Provide the Manager with updates on all issues regarding quality, training, policy, procedures, personnel, and departmental performance levels.
- Ensure compliance with company Wage & Hour policy, including ensuring non-exempt employees get the rest & meal breaks.
- Comply with all company required policies, procedures and processes including but not limited to required training.

- Supervises semi-skilled employees or a few individual professional contributors.
- Frequently interacts with subordinate employees and functional peer groups.
- Evaluate subordinates' job performance and recommend appropriate personnel action.
- Discuss job performance concerns with subordinates to identify causes and issues and works closely with the Human Resources department on resolving problems.
- Identify training needs and development opportunities for subordinates.

- Oversee Appeal Officer functions associated with the independent external appeals process and provide daily supervision of Appeals Officers to successfully fulfill contract.

- Give advice, counsel or instructions to Appeals Officers regarding issues, question that arise with external appeal cases.

- Maintain an active case load and provide coverage as needed for Appeal Officers, including review of patient records and associated review documents, documentation of all review information utilizing the appropriate medical review form, report and/or system, utilization of Internet and Intranet resources for applicable research and preparation of the decision letter or report for each case.

Minimum Requirements:

- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.

- Minimum 2-year experience with independent external review for medical appeals.

- Previous supervisory experience in a medical appeals environment.

-Strong written and oral communication skills, including the ability to communicate effectively and professionally with all levels of the organization.

-Must be a dependable professional with excellent organizational and interpersonal skills

-Must be a self-starter, detail oriented and focused on results with strong analytical and problem-solving skills
-Exceptional skills in work planning and workflow organization, and ability to measure

performance against clearly-defined standards.

Home Office Requirements

-Internet speed of 25mbps or higher download and a upload of 10mbps or higher required (you can test this by going to www.speedtest.net)

-Preferred Windows or Mac (no Chromebooks)

-Hardwired internet (ethernet) connection

-Private work area and adequate power source

Minimum Requirements

- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.

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

$

64,300.00

Annual Base Pay Maximum for this Position

$

75,000.00