Appeal Specialist - Child Care Services

Equus•San Antonio, TX

About The Position

The Appeal Specialist reviews, investigates, and resolves appeals submitted by parents, guardians, or applicants concerning Child Care Services eligibility determinations and other program decisions, including benefit reductions, suspensions, terminations, and co-payment assessments. The role ensures appeals are handled fairly and consistently in accordance with applicable federal, state, and local regulations, contractual requirements, and program procedures. As a neutral reviewer, the specialist conducts fact-finding, evaluates eligibility documentation, interprets program policies, facilitates hearings when required, and prepares written determinations. The position supports due process and the integrity of the Child Care Services program. The specialist also maintains accurate appeal records, monitors deadlines, prepares correspondence and case documentation, supports quality assurance and audits, identifies trends, and provides technical guidance on appeal procedures and eligibility policies. The role requires confidentiality and professionalism when working with sensitive participant information. Additional duties may be assigned.

Requirements

Associate's degree required; an equivalent combination of education and experience may be considered.
Two years of experience in eligibility determination, case management, appeals processing, social services, workforce development, public assistance programs, or a related field.
Experience interpreting policies, regulations, or program requirements.
Experience handling confidential or sensitive information.
Knowledge of Child Care Services eligibility requirements and applicable program regulations.
Ability to interpret policies, procedures, laws, and eligibility guidelines.
Strong analytical, investigative, and critical-thinking skills.
Excellent written and verbal communication skills.
Ability to conduct objective reviews and make impartial decisions.
Strong attention to detail and organizational skills.
Ability to manage multiple cases and meet established deadlines.
Experience preparing professional reports, determinations, and correspondence.
Proficiency with Microsoft Office Suite and case management systems.
Strong customer service and conflict-resolution skills.
Ability to maintain confidentiality and professionalism when dealing with sensitive matters.

Nice To Haves

Bachelor's degree in Public Administration, Social Services, Business Administration, Human Services, Education, Legal Studies, or a related field.
Experience working with child care assistance programs, public benefits, or government-funded programs.

Responsibilities

Receive, review, and process Child Care Services appeal requests within established timeframes.
Review eligibility determinations, supporting documentation, and case records.
Investigate disputed decisions involving income eligibility, family composition, employment status, residency, participation requirements, and other eligibility factors.
Apply Child Care Services policies, Texas Workforce Commission regulations, and local board procedures when making appeal decisions.
Communicate with applicants, parents, guardians, eligibility specialists, providers, workforce staff, and other stakeholders to gather information.
Schedule, coordinate, and facilitate informal reviews, appeal hearings, or administrative review conferences as required.
Prepare case summaries, findings of fact, recommendations, and written appeal determinations.
Maintain complete and accurate appeal records in case management systems and ensure documentation meets audit standards.
Initiate and establish payment plans and document recoupments.
Monitor appeal deadlines and ensure required actions are completed within regulatory timeframes.
Draft and issue appeal outcome letters and related correspondence.
Identify trends in eligibility determinations and recommend process improvements.
Assist with quality assurance reviews, audits, monitoring, and corrective action initiatives.
Provide technical guidance on appeal procedures and Child Care Services eligibility policies.
Ensure compliance with federal, state, local, and contractual requirements governing Child Care Services programs.
Maintain the confidentiality of participant information and records.
Perform other duties as assigned.