Essential Duties and Responsibilities:
- Analyze appeals data using federal and/or state laws and regulations, along with technical direction, guidance, tools, and standard operating procedures provided by the project or client. Detect and correct any errors found.
- Issue informal resolution based on review of an appeal case by obtaining information from various resources.
- Conformance with requirements and technical soundness of completed work are reviewed by the supervisor, or are controlled by mechanisms built into the appeals processes.

- Issue informal resolution based on review of an appeal case by obtaining information from various resources, including utilization of the Income Verification Tool/calculator.- Analyze appeals data using federal and/or state laws and regulations along with technical direction, guidance, tools and standard operating procedures provided by unit or client.- Contact the appellant for more information and to clarify questions.- Find any errors during completion of template and correct errors to ensure timely processing Provide telephone outreach to the appellants to explain the results of the IR determination and respond to inquiries based on the standard procedure/process.- Initiate and terminate pended benefits coverage to determine the appellant’s eligibility during the adjudication of the appeal.- Utilize the Marketplace Change Utility to update appellant applications using information and documentation collected during the appeal process.- Use specialized tools for complex effectuation scenarios to ensure proper allocation of subsidies.- Perform other functions as requested by management within scope of level or provide occasional support of lower level functions as business and volume needs require.- Receive inbound calls, transferred from the Call Center, to schedule hearings for appellants/authorized representative who did not receive their desired outcome through the Informal Resolution Process.- Review appeals to verify that an Informal Resolution was issued and confirm that the appellant/authorized representative is dissatisfied with the informal resolution.- Review the appeal for Language Assistance and Accommodation requests to ensure the proper timeframe allotment for the hearing.- Complete an Urgency Determination Tool to determine scheduling priority.- Discuss appellant/authorized representative preferences regarding availability for a hearing.- Track available timeslots in which a hearing can be scheduled.- Provide the appellant/authorized representative with the date/time of their scheduled hearing, update scheduling information in EACMS, and issue a Notice of Hearing confirming the date/time of the scheduled hearing.- Other scheduling related duties as assigned. Minimum Requirements
- High School diploma or equivalent required.
- At least two (2) years of related experience required.
- Associate degree from an accredited college or university preferred.
- May have additional training or education in area of specialization. - Associate's Degree from an accredited college or university or equivalent experience required. Bachelor's Degree from an accredited college or university in business or related field preferred.- At least two (2) years of related experience required.- More than two (2) years of experience in healthcare or appeals preferred.- Strong attention to details and proven ability to determine course of action based on multiple sources of information.- Intermediate to advanced skill level in use of personal computer and related software applications such as Microsoft Word, Excel or Access.- Ability to type 35 words per minute accurately.- Excellent organizational, interpersonal, written and verbal communication skills.- Ability to perform comfortably in a fast-paced, deadline-oriented work environment.- Ability to successfully execute tasks simultaneously.- Ability to work as a team member, as well as independently.- Ability to work a schedule of 7:30am - 4pm EST Monday - Friday required.

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 For positions on this contract, Maximus will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor. That wage rate will vary depending on locality. An applicant's salary history will not be used in determining compensation.