Manager - Appeals

Manager - Appeals

Maximus is currently hiring for a Manager - Appeals to join our Federal Exchange Review Process (FERP) team. This is a remote opportunity. The Manager is responsible for overseeing the day-to-day operations of the Appeals department, ensuring compliance, operational excellence, and a high-quality customer experience.

This position will require a federal suitability clearance post-hire as mandated by the client.

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
• 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

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.

Minimum Salary $72,700

Maximum Salary $82,500