Technical Adjudicator

Job Locations US-AL-Remote
Posted Date 1 week ago(2/8/2018 2:50 PM)
Requisition ID
# of Openings
Job Function
Job Schedule
Regular Full-Time


MAXIMUS is a leading operator of government health and human services programs and has partnered with state, federal and local governments to provide critical, high quality health and human service programs to a diverse array of communities. Operating under MAXIMUS’s founding mission of Helping Government Serve the People® since 1975, MAXIMUS Federal Services is entirely focused on helping government agencies run programs cost-effectively and serve program constituents with improved outcomes. By being a responsible steward for government programs, we help the federal government deliver on its promises through our people, process and technology. Our focus is always on outcomes and results that connect citizens more effectively with government services.


Adjudicate reconsideration determinations for disputes between enrollees and Medicare Plans by using federal law, federal regulations, relevant contract law and other resources as defined by the client contractor.



  • Adjudicate reconsideration determinations for disputes between enrollees and Medicare Plans by using federal law, federal regulations, relevant contract law and other sources as defined by the client contract. Decisions are determined by acquiring all necessary information involving cases
  • Create reconsideration decision letters for enrollees, and the appellant (if applicable) to explain complex Medicare coverage policies and decisions using a concise, thorough, and professional but readable language. Also, ensures that the letter is sent to all appropriate parties as required by the specific client contract
  • Participate in other activities such as training, attending team meetings
  • Medicare MAC experience in claims process, appeals, medical review
  • Billing experience in areas of home health, labs, radiation, chemotherapy and drugs preferred
  • Perform other duties as assigned by leadership

The Ideal Candidate will Possess the Following Additional Education and Experience

  • High School and/or Associates in lieu of degree equivalent experience; higher preferred

  • Ability to execute multiple complex tasks simultaneously
  • Ability to communicate and present effectively, orally and in writing
  • Work as a team contributor and an individual contributor
  • Strong computer skills with proficiency in Microsoft Office required
  • Ability to maintain confidential and sensitive information
  • Coding/Billling/Medical records ceritifications preferred

EEO Statement

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.


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