Manager - Appeals

This is a remote opportunity. A federal suitability clearance is required post-hire as mandated by the client.

About the role

The Manager oversees the day-to-day operations of the Appeals department, ensuring compliance, operational excellence, and a high-quality customer experience.

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).
• Oversee the day-to-day operations of the Appeals department.
• Ensure appeals are reviewed and resolved in a timely manner.
• Maintain accuracy and consistency in appeal determinations.
• Ensure compliance with regulatory, contractual, and company requirements.
• Monitor team performance, productivity, and workload distribution.
• Perform Monthly Quality Checks.
• Provide monthly and as-needed coaching, guidance, and performance feedback to team members.
• Oversee compliance with policies, procedures, and regulatory guidelines.
• Identify and implement process improvement opportunities.
• Drive operational efficiency and workflow optimization.
• Analyze trends and performance metrics to improve outcomes.
• Collaborate with management to address escalated issues.
• Support a positive customer experience through fair and effective appeal resolution.
• Promote continuous improvement initiatives to enhance service quality and customer satisfaction.
• Perform other duties as assigned by management.

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 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.

Home Office Requirements

• Internet speed of 25mbps or higher required / 50 Mbps for shared internet connectivity (test at www.speedtest.net).
• Minimum 5mbps 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.

Pay

Annual salary range: $72,700.00 – $82,500.00.

Maximus compensation is based on various factors including 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. 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.