Manager - Appeals

Essential Duties and Responsibilities: - Manage assigned teams and staff. - Develop, monitor, and use quality control procedures and audit criteria to ensure consistent application of contractual requirements and established policies and procedures. - Frequent interaction with subordinate employees, customers, and/or functional peer group managers, normally involving matters between functional areas, other company divisions or units, or customers and the company. - Provide guidance to subordinates within the latitude of established company policies. - Recommend changes to policies and establish procedures that affect immediate organization(s). - Perform other duties as assigned by management. - Oversees the day-to-day operations of the Appeals department. - Ensures appeals are reviewed and resolved in a timely manner. - Maintains accuracy and consistency in appeal determinations. - Ensures compliance with regulatory, contractual, and company requirements. - Monitors team performance, productivity, and workload distribution. - Performs Monthly Quality Checks. - Provides monthly and as-needed coaching, guidance, and performance feedback to team members. - Oversees compliance with policies, procedures, and regulatory guidelines. - Identifies and implements process improvement opportunities. - Drives operational efficiency and workflow optimization. - Analyzes trends and performance metrics to improve outcomes. - Collaborates with management to address escalated issues. - Supports a positive customer experience through fair and effective appeal resolution. - Promotes continuous improvement initiatives to enhance service quality and customer satisfaction. Minimum Requirements - Bachelor's degree in relevant field of study and 5+ years of relevant professional experience required, or equivalent combination of education and experience. - Familiarity with Appeals & Hearings is required. Expertise within the Hearings & Appeals function is strongly preferred. - Current and/or prior managerial experience. - Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday. - Flexibility to work extended hours and rotational weekends. Preferred Skills and Qualifications: - Knowledge of and experience with healthcare appeals. - Quality check, review, and/or assessment experience. - Experience working with Salesforce. - Familiarity with the Affordable Care Act. 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 EEO Statement 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. 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. Accommodations Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at applicantaccom@maximus.com. Minimum Salary $ 72,700.00 Maximum Salary $ 82,500.00 *