Fair Hearing Specialist

State of Vermont; Waterbury (CT); Hybrid; USD 52,000 - 72,000; Full time

Benefits offered by this job

Hybrid work environment

12 paid state holidays

Comprehensive benefits package

Work-life balance

Job summary

The Department of Vermont Health Access (DVHA) seeks a Fair Hearing Specialist to review Medicaid and Vermont Health Connect eligibility determinations. The role offers a Monday–Friday schedule with a supportive hybrid work environment and 12 paid state holidays as part of a robust benefits package.

Minimum qualifications include a relevant degree with specified years of experience; completion of background checks is required. Travel and court appearances may be necessary.

Qualifications

• Bachelor's degree with 1+ year in a technical level role including research or customer service.
• Associate's degree with 3+ years in a similar role.
• High School diploma with 5+ years in a similar role.

Responsibilities

• Conduct detailed review of cases brought by members disputing Medicaid or Vermont Health Connect determinations.
• Track changes to policies and rules.
• Correct errors in the system and outreach customers when needed.
• Work closely with the Assistant Attorney General's office in hearings.
• Manage conflicting priorities and meet deadlines.
• Provide superior customer service and multi-task as needed.

Skills

Customer service

Research

Healthcare services review

Education

Bachelor's degree

Associate's degree

High School diploma or equivalent

Job description

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Provide superior customer service to members who are in disagreement with Medicaid or Vermont Health Connect health eligibility determinations. The Health Care Appeals unit at the Department of Vermont Health Access (DVHA) is looking for a Fair Hearing Specialist (FHS) to fill this rewarding role. Have the work/life balance you need with a Monday-Friday schedule and a supportive hybrid work environment. 12 paid state holidays, in addition to a robust benefits package.

The Fair Hearing Specialist position has the following responsibilities:

• Conduct detailed review of cases brought by members who are in disagreement with a Medicaid or Vermont Health Connect healthcare eligibility determination.
• Track changes to policies and rules.
• Correct errors in the system and in some instances outreach customers to confirm disappointing decisions.
• work closely with the Assistant Attorney General's office, who represent the department in hearings.
• Manage conflicting priorities.
• Meet deadlines and provide superior customer service under difficult circumstances.
• Multi-task as needed.

Mission: The Department of Vermont Health Access (DVHA)'s mission is to improve Vermonters' health and well-being by providing access to high-quality, cost-effective health care. We have identified three priorities that support our mission: Advancing value-based payments, modernizing information technology infrastructure, and operational performance improvement. Our department commits to executing our responsibilities and priorities while adhering to three core values: Transparency, Integrity and Service.

Diversity, Equity, and Inclusion: As part of our values of transparency, integrity, and service, we are committed to supporting diversity, equity, inclusion, and accessibility as part of our person-centered culture. We actively celebrate our colleagues' and future colleagues' different abilities, racial identity, sexual orientation, ethnicity, age, and gender. Everyone is welcome and supported here.

Our State: Vermont is a "small but mighty" state. We are ranked as one of the top 10 states to raise a family in 2022. We are nationwide leaders for progressive social and educational policies. We are in Northern New England, 1.5 hours from Montreal and 3.5 hours from Boston. We have beautiful Lake Champlain, the Green Mountains, and year-round outdoor activities.

AHS BACKGROUND CHECKS: Candidates must pass any level of background investigation applicable to the position. In accordance with AHS Policy 4.02, Hiring Standards, Vermont and/or national criminal record checks, as well as DMV and adult and child abuse registry checks, as appropriate to the position under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion or demotion into an AHS classified position or are persons exercising re-employment (RIF) rights.

Duties are performed in a standard office setting. Some travel may be necessary, for which private transportation must be available. Stressful interaction with upset or emotional clients may occur. Staff workload may frequently be heavy. Work outside of typical business hours may be expected and incumbents might be required to appear in court, representing the State of Vermont.

Minimum Qualifications

Bachelor's degree AND one (1) or more years at or above a technical level role that includes research, customer service, review of healthcare services or similar field

OR

Associate's degree AND three (3) or more years at or above a technical level role that includes research, customer service, review of healthcare services or similar field.

OR

High School diploma or equivalent AND five (5) or more years at or above a technical level role that includes research, customer service, review of healthcare services or similar field.

Total Compensation

As a State employee you are offered a great career opportunity, but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits that are worth about 30% of your total compensation, including:

• 80% State paid medical premium and a dental plan at no cost for employees and their families
• Work/Life balance: 12 paid holidays each year and a generous leave plan
• State Paid Family and Medical Leave Insurance (FMLI)
• Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
• Tuition Reimbursement
• Flexible spending healthcare and childcare reimbursement accounts
• Low cost group life insurance
• Incentive-based Wellness Program
• Qualified Employer for Public Service Student Loan Forgiveness Program

The State of Vermont celebrates diversity, and is committed to providing an environment of mutual respect and meaningful inclusion that represents a variety of backgrounds, perspectives, and skills. The State does not discriminate in employment on the basis of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, membership in an employee organization, family medical history or genetic information, or family or parental status. The State’s employment decisions are merit-based. Retaliatory adverse employment actions by the State are forbidden.