Appeal Specialist - Child Care Services

Equus•San Antonio, TX

10d

About The Position

The Appeal Specialist reviews, investigates, and resolves appeals submitted by parents, guardians, or applicants concerning Child Care Services (CCS) eligibility determinations, benefit reductions, suspensions, terminations, co-payment assessments, and other program decisions. The role ensures appeals are handled fairly and consistently, in compliance with federal, state, and local regulations, contractual requirements, and established program procedures. The Appeal Specialist serves as a neutral reviewer, conducting fact-finding, evaluating eligibility documentation, interpreting CCS policies, facilitating hearings when required, and preparing written determinations. The position also maintains appeal records, monitors deadlines, communicates with participants and program stakeholders, supports audits and quality assurance activities, identifies trends, and provides technical guidance on appeal procedures and CCS eligibility policies. It requires an associate's degree or an equivalent combination of education and experience, along with two years of relevant experience.

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, and other eligibility factors.
Analyze Child Care Services policies, Texas Workforce Commission regulations, and local board procedures.
Communicate with applicants, parents, guardians, eligibility specialists, providers, workforce staff, and other stakeholders to obtain information for case resolution.
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 complete required actions within regulatory timeframes.
Draft and issue appeal outcome letters and related correspondence.
Identify eligibility determination trends 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 applicable federal, state, local, and contractual requirements.
Maintain confidentiality of participant information and records.
Perform other duties as assigned.