68021869 - SENIOR HUMAN SERVICES PROGRAM SPECIALIST

Florida; Fort Myers (FL); On-site; USD 52,000 - 68,000; Full time

Job summary

The Agency for Health Care Administration (AHCA) seeks a Senior Human Services Program Specialist to strengthen the Florida Medicaid program and improve health care delivery across the state. This role emphasizes compliance, problem solving, and collaboration within a team environment.

Based in the Bureau of Medicaid Recipient Services, the position focuses on administering fair hearings, resolving issues efficiently, and communicating with constituents while aligning with AHCA's mission and

Qualifications

• Two years of experience providing a professional level of customer service in a fast-paced consumer environment.
• Moderate to extensive experience and abilities using different computer programs such as Excel, Outlook, and Word, including typing accuracy.

Responsibilities

• Review and process Medicaid fair hearing submissions to ensure issues are correctly entered.
• Search for pertinent Federal laws, regulations, state statutes, and Medicaid rules as needed.
• Coordinate with SMMC plans, TPAs, and providers on plan provisions and amendments.
• Provide updates to constituents and maintain communication throughout the resolution process.
• Monitor and triage assignment messages to ensure timely processing and escalation when necessary.

Skills

Customer service

Communication

Tools

Excel

Outlook

Word

Job description

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68021869 - SENIOR HUMAN SERVICES PROGRAM SPECIALIST

Date: Oct 19, 2026

The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website .

Requisition No:885890

Agency: Agency for Health Care Administration

Working Title: 68021869 - SENIOR HUMAN SERVICES PROGRAM SPECIALIST

The Agency for Health Care Administration (AHCA) is Florida's chief health policy and planning entity.

The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities, and empowering consumers through health care transparency initiatives.

Under the direction of the Agency Secretary, AHCA is focused on advancing Governor DeSantis’ vision for Florida’s health care system to be the most cost-effective, transparent, and high-quality health care system in the nation.

The Medicaid program provides low-income families and individuals with access to health care.

If you have a desire to use your talent and skills at an organization that provides critical services to millions of individuals and families across the state, AHCA invites you to apply to become an essential member of our team.

As one of Florida’s leading state agencies, AHCA’s diverse workforce community of more than 1,400 employees is proud of its efforts to serve the people of Florida.

Agency Objectives:

HIGH QUALITY

Emphasizing quality in all that we do to improve health outcomes, always putting the individual first.

TRANSPARENT

Supporting initiatives that promote transparency and empower consumers in making well informed healthcare decisions.

COST-EFFECTIVE

Leveraging Florida’s buying power in delivering high quality care at the lowest cost to taxpayers.

Position Overview:

This is an exciting opportunity to help shape the quality of health care in Florida.

We are seeking to hire a Senior Human Services Program Specialist who desires to work to enhance the delivery of health care services through the Florida Medicaid Program.

This position requires a candidate who is creative, flexible, innovative, and who will thrive in a fast-paced, team based work environment.

This position is located in the Bureau of Medicaid Recipient Services (MRS).

MRS serves as a primary point of contact for Medicaid recipients, and members of the community with questions and concerns about Medicaid.

This position is responsible for maintaining up-to-date knowledge about the Florida Medicaid program by participating in Agency training opportunities and through self-education utilizing available resources, including but not limited to, the Agency’s internal and external web sites, provider alerts, and MRS share point sites.

The incumbent knows how to search for pertinent Federal laws and regulations, applicable state statutes and Medicaid rules, as needed.

The incumbent remains informed about Agency projects and initiatives by participating in available webinars and staff meetings, and by subscribing to provide alerts.

The incumbent remains knowledgeable about Statewide Medicaid Managed Care (SMMC) contract provisions and amendments, SMMC talking points and guidance statements, SMMC plan subcontractors and TPAs, and information shared via SMMC all-plan communications distributed by the Agency.

The incumbent completes an assessment of newly assigned fair hearing requests to confirm issues were correctly entered into the complaint module based on the information available.

Should errors be identified, the incumbent makes corrections as appropriate and alerts their supervisor for staff training purposes. Searches for duplicate active complaint submissions, per current protocol.

The incumbent requests legal sufficiency documents from the appropriate SMMC plan or FFS vendor to submit to the Office of Fair Hearing (OFH).

Confirms that disputed services remain in place pending the outcome of the hearing, when appropriate.

The incumbent assigns an Agency fair hearing liaison to attend the hearing and requests respondent evidence from the appropriate party.

Ensures related documents are processed and shared with OFH, per current protocols.

The incumbent monitors active fair hearings to ensure appropriate and timely updates are made in the complaint module, alerting their supervisor of any identified issues or concerns.

The incumbent reviews assignments received via the MedicaidHearingUnit box to ensure all messages and related documents are triaged and processed promptly.

Alerts their supervisor of any potential issues/concerns regarding these submissions that prevent or delay processing.

The incumbent researches and responds to Legislative Assignments, CorrFlow, and other priority issues related to the fair hearing process, as assigned.

Contact the constituent to obtain information, as needed.

Provides updates on actions taken to resolve the issue while maintaining communication with constituents throughout the process.

The incumbent represents the Agency on government and community partnerships, community outreach events, Secret Shopper assignments, Medicaid overview presentations, transportation boards, community alliances, interagency agreement teams, local planning groups, HIV planning councils and social services agency forums as assigned.

Performs other duties as assigned.

This is an anticipated vacancy.

This position is not a remote or telework position.

Benefits of working for the State of Florida:

Working for the State of Florida is more than a paycheck. We offer an excellent array of benefits, including:

• Health insurance (i.e., individual and family coverage) to eligible employees
• Life insurance; $25,000 policy is free plus option to purchase additional life insurance
• Dental, vision and supplemental insurance
• State of Florida retirement options, including employer contributions
• Ability to earn up to 104 hours of paid annual leave as a new employee with the State of Florida
• Ability to earn up to 104 hours of sick leave annually
• Nine paid holidays and 1 personal holiday each year
• Opportunities for career advancement
• Tuition waivers (accepted by major Florida Colleges/universities)
• Student loan forgiveness opportunities (eligibility required)
• Shared Savings Program for select medical services
• Lower copays for prescription drugs
• Health and Wellness discounts

For a more complete list of benefits, please visit https://www.mybenefits.myflorida.com/

For more information about the Bureau of Medicaid Recipient Services, please visit our website at http://ahca.myflorida.com/Medicaid/index.shtml.

Join us at the Agency for Health Care Administration in fulfilling our mission to provide “Better Health Care for all Floridians.”

KNOWLEDGE, SKILLS, AND ABILITIES

Ability to communicate effectively, verbally and in writing.

Ability to determine work priorities, assign work and ensure proper completion of work assignments within established timeframes.

Ability to establish and maintain effective working relationships with others.

Ability to investigate, analyze, and resolve complaints.

Ability to organize data into a logical format for presentations, reports, and other written materials.

Ability to provide training to providers, coworkers, and community agencies.

Ability to review and evaluate plans and programs.

Ability to solve problems and make decisions in a timely manner.

Ability to understand and apply applicable rules, regulations, policies, and procedures.

Ability to use databases.

Ability to utilize Microsoft Office Suite.

Ability to work independently.

Ability to travel with or without accommodation.

MINIMUM QUALIFICATIONS REQUIREMENTS

Two years of experience providing a professional level of customer service in a fast-paced consumer‑centric environment.

Preference will be given to the applicant that has:

Moderate to extensive experience and abilities using different computer programs such as Excel, Outlook, and Word, etc., including quick and accurate typing/keyboarding skills.

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS

N/A

CONTACT:

STEPHANIE REEVES 239-335-1313

BACKGROUND SCREENING

It is the policy of the Florida Agency for Health Care Administration that any applicant being considered for employment must successfully complete a State and National criminal history check as a condition of employment before beginning employment, and, if applicable, also be screened in accordance with the requirements of Chapter 435, F.S., and Chapter 408, F.S. No applicant may begin employment until the background screening results are received, reviewed for any disqualifying offenses, and approved by the Agency. Background screening shall include, but not be limited to, fingerprinting for State and Federal criminal records checks through the Florida Department of Law Enforcement (FDLE) and Federal Bureau of Investigation (FBI) and may include local criminal history checks through local law enforcement agencies.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE.

Pursuant to Chapter 295, Florida Statutes,candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans’ Preference documentation requirements are available by clicking here . All documentation is due by the close of the vacancy announcement.

Location: FT MYERS, FL, US, 33901 FORT MYERS, FL, US, 33966 FT MYERS BEACH, FL, US, 33931 FORT MYERS, FL, US, 33994 FORT MYERS, FL, US, 33912 FORT MYERS, FL, US, 33916 FT MYERS, FL, US, 33905 FORT MYERS, FL, US, 33907 FT MYERS, FL, US, 33913 FORT MYERS, FL, US, 33913 NORTH FORT MYERS, FL, US, 33903 FORT MYERS, FL, US, 33919 FORT MYERS, FL, US, 33908 FORT MYERS, FL, US, 33902

Nearest Major Market: Fort Myers

Nearest Secondary Market: Cape Coral

For assistance, call the People First Service Center at [phone] Monday - Friday, 8:00 a.m. to 6:00 p.m., Eastern time. Pursuant to Florida Law, 110.211 F. S., the State of Florida is an EEO employer.