Appeals Support Specialist

Appeals Support Specialist

Position Summary

The Appeals Support Specialist provides administrative and programmatic support for the appeals process. This position reviews appeal cases for procedural accuracy, identifies potential errors, supports hearing operations, processes appeal-related actions, and assists with the resolution of overpayment referrals.

Essential Duties and Responsibilities

• Review appeals pending a hearing and taking appropriate actions to ensure cases are processed in accordance with established policies and timelines.
• Analyze appeal cases to determine whether actions or errors contributed to the appeal filing.
• Document findings, prepare detailed case summaries, identify corrective actions, and submit recommendations to designated staff for review and processing.
• Provide support for administrative hearings, including attendance as a designated representative or hearing participant when required.
• Assist in managing hearing schedules and maintaining coverage for scheduled proceedings to support efficient utilization of resources.
• Review appeal decisions and determine required follow-up actions based on hearing outcomes and procedures.
• Process overpayment referrals resulting from appeal decisions, ensuring accuracy and compliance with applicable regulations.
• Maintain accurate case records, documentation, and tracking information related to appeals and hearing activities.
• Collaborate with staff, supervisors, and other stakeholders to resolve case issues and ensure timely completion of appeal-related tasks.
• Adhere to confidentiality requirements and maintain compliance with all applicable policies.

Required Qualifications

• Associate degree.
• Strong analytical and critical thinking skills with the ability to identify discrepancies and procedural issues.
• Experience documenting findings and preparing clear summaries and recommendations.
• Proficiency with case management systems and Microsoft Office applications.
• Ability to interpret policies, procedures, and regulations and apply them. 
• Excellent written and verbal communication skills.
• Strong organizational skills and ability to manage multiple priorities in a high-volume environment.

Preferred Qualifications

• Experience working with eligibility determination, appeals, or hearing processes.
• Experience reviewing case records, determining eligibility, or supporting administrative hearings. 
• Experience processing overpayments, claims, or recovery actions.
• Familiarity with administrative hearing procedures and legal documentation requirements.

Knowledge, Skills, and Abilities

• Ability to analyze complex case information 
• Ability to communicate findings clearly and professionally.
• Attention to detail and accuracy in case review and documentation.
• Ability to work independently while meeting productivity and quality standards.
• Strong customer service and stakeholder support skills.
• Ability to handle confidential and sensitive information with discretion.

Rate of pay: $20 hourly with benefits

• 401(k)

• Dental insurance
• Vision Insurance
• Disability insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Paid Holidays