Eligibility Appeals Officer – Legal Rulings & Due Process

Commonwealth of VA Careers; Richmond (VA); On-site; USD 89,000 - 96,000; Full time

Job summary

The Department of Medical Assistance Services (DMAS) is seeking an Eligibility Hearing Officer to join the Appeals Division in Virginia. The role involves reviewing appeal requests, documents, and evidence to conduct eligibility hearings and render decisions within established timeframes, ensuring due process and legal soundness.

You will apply administrative law knowledge, conduct legal research, and manage a caseload while delivering excellent customer service and forming a collaborative work

Qualifications

• Experience independently managing a caseload to meet established time frames.
• Considerable work‑related experience applying rules to facts to reach logical, legally supportable conclusions.
• Knowledge of administrative law and / or appeals procedures.
• Considerable knowledge of legal research methodologies, including computerized legal research.
• Considerable experience with technology, including MS Office.
• Considerable experience interpreting, applying, and analyzing federal and state complex laws, regulations, policies, or case law.
• Experience in meeting deadlines.
• Experience with internal/external stakeholders.
• Considerable experience in legal analysis and legal writing.

Responsibilities

• Review appeal requests, case documents, and other appropriate evidence to prepare for and conduct client eligibility appeal hearings.
• Render written appeal decisions at the highest administrative level in accordance with fair hearing principles and within established timeframes.
• Apply knowledge of laws, rules, and regulations in the decision process to independently render decisions based on findings of fact and conclusions of law; apply knowledge of administrative procedures for conducting hearings, due process standards, and legal research methods; conduct legal research; engage in thorough, accurate, and objective analysis and evaluation of facts, evidence, and law in order to make legally sound and defensible recommendations and judgments; and independently manage a caseload to ensure timely compliance with deadlines.
• Provide excellent customer service, treating everyone who interacts with the Division with respect and dignity; ensure every appellant receives full due process; support a collaborative and positive work environment; and produce a quality work product.

Skills

Caseload management

Legal analysis

Legal writing

Regulatory knowledge

Legal research

Stakeholder communication

Tools

MS Office

Job description

The Department of Medical Assistance Services (DMAS) is seeking an Eligibility Hearing Officer to join the Appeals Division in Virginia. The role involves reviewing appeal requests, documents, and evidence to conduct eligibility hearings and render decisions within established timeframes, ensuring due process and legal soundness.

You will apply administrative law knowledge, conduct legal research, and manage a caseload while delivering excellent customer service and forming a collaborative work