Fair Hearing Specialist

State of Vermont • Waterbury, VT

2d • Hybrid

About The Position

The Fair Hearing Specialist (FHS) works in the Health Care Appeals unit at the Department of Vermont Health Access (DVHA), providing customer service to members who disagree with Medicaid or Vermont Health Connect health eligibility determinations. The role involves reviewing cases, tracking changes to policies and rules, correcting system errors, and, in some cases, contacting customers to confirm unfavorable decisions. The specialist works closely with the Assistant Attorney General's office, which represents the department in hearings.

The position requires managing conflicting priorities, multitasking, meeting deadlines, and providing customer service in difficult circumstances. Duties are performed in a standard office setting, with a supportive hybrid work environment and a Monday–Friday schedule. Some travel may be necessary, and private transportation must be available. The role may involve stressful interactions with upset or emotional clients, a frequently heavy workload, work outside typical business hours, and appearances in court representing the State of Vermont.

The Department of Vermont Health Access's mission is to improve Vermonters' health and well-being by providing access to high-quality, cost-effective health care. Its priorities include advancing value-based payments, modernizing information technology infrastructure, and improving operational performance. The department's core values are transparency, integrity, and service, and it is committed to diversity, equity, inclusion, and accessibility.

Candidates must pass any background investigations applicable to the position, which may include Vermont and/or national criminal record checks, DMV checks, and adult and child abuse registry checks. Certain exceptions apply to current classified state employees seeking transfer, promotion, or demotion into an AHS classified position and people exercising re-employment (RIF) rights.

Requirements

• Bachelor's degree and at least one year of experience at or above a technical-level role involving research, customer service, review of healthcare services, or a similar field; OR associate's degree and at least three years of such experience; OR high school diploma or equivalent and at least five years of such experience.
• Must pass applicable background investigations, which may include criminal record, DMV, and adult and child abuse registry checks.
• Private transportation must be available if travel is necessary.

Responsibilities

• Conduct detailed reviews of cases brought by members who disagree with Medicaid or Vermont Health Connect healthcare eligibility determinations.
• Track changes to policies and rules.
• Correct errors in the system.
• In some cases, contact customers to confirm unfavorable decisions.
• Work closely with the Assistant Attorney General's office, which represents the department in hearings.
• Manage conflicting priorities.
• Meet deadlines and provide customer service under difficult circumstances.
• Multitask as needed.
• Appear in court representing the State of Vermont when required.

Benefits

• 80% state-paid medical premium and a dental plan at no cost for employees and their families.
• 12 paid holidays each year and a generous leave plan.
• State-paid Family and Medical Leave Insurance (FMLI).
• State defined benefit pension plan and deferred compensation 457(b) plan.
• Tuition reimbursement.
• Flexible spending healthcare and childcare reimbursement accounts.
• Low-cost group life insurance.
• Incentive-based wellness program.
• Eligibility as a qualified employer for the Public Service Student Loan Forgiveness Program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level