Consultant - Appeals (Remote)
MAXIMUS services as an independent review organization (IRO) for several states.
An IRO acts as a third-party medical review resource which provides objective, unbiased medical determinations that support effective decision making, based only on medical evidence.The Consultant – Appeals position supports the medical review process.
Essential Duties and Responsibilities:
- Must be available to work rotating weekends/holidays as scheduled in advance.
- Review case files to ascertain/confirm dispute.
- Review and analyze case files to ensure all necessary documents are available for the review.
- Prepare case for medical reviewer by organizing files and creating review form.
- Analyze and conduct quality control of medical reviewer's assessment.
- Compile case files and information into final review deliverable.
- Communicate with stakeholders by phone and/or email.
- Accurate and timely data entry into case management system.
- Identify, resolve, communicate, and escalate issues/risks.
- Perform other duties as assigned by leadership.
Must have experience with self-organization of work based on priorities. Must be able to plan work based on caseload.
JDSkills / Knowledge Required:
Working knowledge and use of PC, MS Word and Excel, excellent organizational, interpersonal, written, and verbal communication skills and ability to perform comfortably in a fast-paced, deadline-oriented work environment; ability to successfully execute many complex tasks simultaneously; ability to work as a team member as well as independently.Ability to quickly learn new systems and adapt to change.
Skills / Knowledge Preferred:
Familiarity with medical terms; licensed attorney.
MAXIMUS IntroductionSince 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs.
Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs.
With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom.For more information, visit
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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 TransparencyMaximus compensation is based on various factors including but not limited to 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 shall be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation.