What are the responsibilities and job description for the Appeals Navigator TERM LIMITED. position at State of Colorado?
Department Information
State Of Colorado Residency Required At Time Of Application
This is a TERM LIMITED position funded through 2/29/2028
NOTE: This announcement may be used to fill multiple openings.
The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP ), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.
We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.
As part of the State of Colorado, HCPF offers a competitive benefits package:
The Legal Division exists to support the legal and privacy issues of the Department. Included in the Legal Division are Benefits Coordination, the data response team consisting of the Privacy Officer and the Legal Analyst, and the Policy Specialist responsible for the submission of State Plan waivers and amendments. The Legal Division is responsible for maintaining the Protected Health Information database that houses information regarding powers of attorney and 2 authorizations. As well, the Legal Division is responsible for the privacy hotline. The Division assists the Department in complying with all applicable federal and state statutes, federal and state regulations, and other policy considerations.
Description Of Job
Key Responsibilities
This position serves as a key resource on Medicaid member appeals for staff, Medicaid members, advocates, and stakeholders. The role supports members who may have limited English proficiency, low health literacy, or limited experience navigating Medicaid and the appeals process by translating complex policies into clear, plain language and providing fair, impartial guidance regarding appeals procedures and case-specific questions. The position advises members, staff, and stakeholders on how to effectively navigate the member appeals process and collaborates closely with Department and vendor staff to review cases, identify appropriate next steps, and ensure action items are completed within required timelines.
The position works collaboratively with member appeals team members to assist in developing hearing strategies and preparing appeals documentation for Department representatives participating in hearings. Responsibilities also include tracking appeal deadlines and maintaining related data to support timely and accurate case management. The role requires collecting, analyzing, comparing, and summarizing information from multiple sources, including notices, motions, complaints, affidavits, briefs, legal decisions, medical records, and other case-related documentation.
This position evaluates appeals cases and operational data to identify opportunities for improvement in databases, processes, metrics, strategies, appeal outcomes, member experience, and Department policies. The role recommends best practices, identifies gaps related to benefits, policies, quality, and access, and contributes to the assessment and development of current and future policies. The position also develops collaborative working relationships with internal and external partners to address policy and program challenges, support process improvements, and advance program goals.
In addition, the position serves as a resource on Medicaid benefits, services, and equipment appeals and interacts regularly with stakeholders and member representatives. The role may act as a backup to the work lead for appeal hearings concerning Medicaid benefits, services, and equipment and may represent the Department before an Administrative Law Judge (ALJ). Responsibilities include participating in the pre-hearing appeals process by conducting preliminary case analysis, reviewing medical records and product research, applying negotiation skills, and exercising sound judgment to determine whether cases should be resolved prior to hearing or presented before the ALJ. The position identifies solutions to improve quality and operational efficiency and may occasionally travel in-state or out-of-state for programmatic or staff development activities as needed.
Residency Requirement
Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights
This posting is only open to residents of the State of Colorado at the time of submitting your application.
Class Code & Classification Description
H1B3XX ADMINISTRATOR III
Minimum Qualifications
Experience Only:
Six (6) of professional experience in public policy or a health or social services-related field involving working knowledge of the Medicaid program, policy research, analysis and implementation, member communication and appeals processes, and stakeholder engagement.
OR
Education And Experience
Bachelor's degree from an accredited institution in Public or Healthcare Policy, Healthcare Administration or Management, Public Health, Social Work, Law Degree or related field
AND
Two (2) years of professional experience in public policy or a health or social services-related field involving working knowledge of the Medicaid program, policy research, analysis and implementation, member communication and appeals processes, and stakeholder engagement.
Preferred Qualifications
Required Competencies
An applicant who has been removed from an employment list or removed from consideration during the selection process may request a review by the State Personnel Director.
As an applicant directly affected by the results of the selection or comparative analysis process, you may file a written appeal with the State Personnel Director.
Review of the completed, signed and submitted appeal will be timely on the basis of written material submitted by you, using the official appeal form signed by you or your representative. This form must be completed and delivered to the State Personnel Board by email at dpa_state.personnelboard@state.co.us within ten (10) calendar days from your receipt of notice or acknowledgement of the Department’s action.
For further information on the Board Rules, you can refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov/board-rules .
Supplemental Information
How to Apply (PLEASE READ CAREFULLY)
Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.
Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.
Comparative Analysis Process
The comparative analysis process will consist primarily of a review of applications against the minimum and preferred qualifications of this position. Applications will be reviewed in comparison to all others in the applicant pool in order to identify a top group of candidates who may be invited for a final interview. Depending on the size of the applicant pool, additional selection processes may be utilized to identify a top group of candidates. Applicants will be notified of their status via email.
Failure to submit properly completed documents by the closing date will result in your application being rejected.
ADAAA Accommodations : The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.
The Department of Health Care Policy & Financing is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Anupreet Kaur, at anupreet.kaur@state.co.us .
The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.
State Of Colorado Residency Required At Time Of Application
This is a TERM LIMITED position funded through 2/29/2028
NOTE: This announcement may be used to fill multiple openings.
The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP ), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.
We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.
As part of the State of Colorado, HCPF offers a competitive benefits package:
- PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans
- Medical , Dental , and Vision insurance coverage
- Automatic Short-Term and Optional Long-Term Disability Coverage
- Life and AD&D Insurance
- Flexible Spending Accounts (FSAs)
- Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML)
- 11 Paid Holidays Annually and Accrued Annual and Sick Leave
- Accrued Sick Leave for State of Colorado Temporary Employees
- Flexplace and Flextime work arrangements
- Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program
- Free RTD EcoPass to all eligible State Employees
- Credit Union of Colorado Membership Eligibility
- Some positions may qualify for the Public Service Loan Forgiveness Program. For more
The Legal Division exists to support the legal and privacy issues of the Department. Included in the Legal Division are Benefits Coordination, the data response team consisting of the Privacy Officer and the Legal Analyst, and the Policy Specialist responsible for the submission of State Plan waivers and amendments. The Legal Division is responsible for maintaining the Protected Health Information database that houses information regarding powers of attorney and 2 authorizations. As well, the Legal Division is responsible for the privacy hotline. The Division assists the Department in complying with all applicable federal and state statutes, federal and state regulations, and other policy considerations.
Description Of Job
Key Responsibilities
This position serves as a key resource on Medicaid member appeals for staff, Medicaid members, advocates, and stakeholders. The role supports members who may have limited English proficiency, low health literacy, or limited experience navigating Medicaid and the appeals process by translating complex policies into clear, plain language and providing fair, impartial guidance regarding appeals procedures and case-specific questions. The position advises members, staff, and stakeholders on how to effectively navigate the member appeals process and collaborates closely with Department and vendor staff to review cases, identify appropriate next steps, and ensure action items are completed within required timelines.
The position works collaboratively with member appeals team members to assist in developing hearing strategies and preparing appeals documentation for Department representatives participating in hearings. Responsibilities also include tracking appeal deadlines and maintaining related data to support timely and accurate case management. The role requires collecting, analyzing, comparing, and summarizing information from multiple sources, including notices, motions, complaints, affidavits, briefs, legal decisions, medical records, and other case-related documentation.
This position evaluates appeals cases and operational data to identify opportunities for improvement in databases, processes, metrics, strategies, appeal outcomes, member experience, and Department policies. The role recommends best practices, identifies gaps related to benefits, policies, quality, and access, and contributes to the assessment and development of current and future policies. The position also develops collaborative working relationships with internal and external partners to address policy and program challenges, support process improvements, and advance program goals.
In addition, the position serves as a resource on Medicaid benefits, services, and equipment appeals and interacts regularly with stakeholders and member representatives. The role may act as a backup to the work lead for appeal hearings concerning Medicaid benefits, services, and equipment and may represent the Department before an Administrative Law Judge (ALJ). Responsibilities include participating in the pre-hearing appeals process by conducting preliminary case analysis, reviewing medical records and product research, applying negotiation skills, and exercising sound judgment to determine whether cases should be resolved prior to hearing or presented before the ALJ. The position identifies solutions to improve quality and operational efficiency and may occasionally travel in-state or out-of-state for programmatic or staff development activities as needed.
Residency Requirement
Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights
This posting is only open to residents of the State of Colorado at the time of submitting your application.
Class Code & Classification Description
H1B3XX ADMINISTRATOR III
Minimum Qualifications
Experience Only:
Six (6) of professional experience in public policy or a health or social services-related field involving working knowledge of the Medicaid program, policy research, analysis and implementation, member communication and appeals processes, and stakeholder engagement.
OR
Education And Experience
Bachelor's degree from an accredited institution in Public or Healthcare Policy, Healthcare Administration or Management, Public Health, Social Work, Law Degree or related field
AND
Two (2) years of professional experience in public policy or a health or social services-related field involving working knowledge of the Medicaid program, policy research, analysis and implementation, member communication and appeals processes, and stakeholder engagement.
Preferred Qualifications
- Current experience working with Medicaid and the healthcare industry, including statutes, and regulations.
- Experience with program evaluation, data analysis, and policy analysis to identify issues, develop solutions, and recommend policy and programmatic improvements.
- Ability to analyze information and evaluate results to choose the best solution and solve problems.
- Proven ability to plan, organize, and prioritize, in order to accomplish work assignments and meet strict deadlines.
- Relevant State of Colorado experience.
Required Competencies
- Ability to read, analyze, understand, and apply laws, rules, policies and procedures;
- Exceptional oral and written communication skills, including the ability to verbally communicate to a diverse audience and the ability to complete reports and communications in a clear, accurate, and concise manner;
- Interpersonal skills, including the ability to build strong relationships and work collaboratively with a variety of different stakeholders, both internal and external;
- Positive attitude and demonstrated ability to remain patient and compassionate when dealing with difficult customer interactions;
- Demonstrated customer service skills, including the ability to use de-escalation techniques to resolve difficult conversations;
- Ability to handle sensitive and/or highly confidential information in a professional and ethical manner, and in accordance with state and federal laws;
- Ability to represent the department in a positive, professional and objective manner, and support a positive workplace environment;
- Accountability for work product and attendance;
- Demonstrated attention to detail;
- Professional demeanor;
- Proficiency in the use of PC software applications including Microsoft Office (Access, Word, Excel, PowerPoint, etc.), and Google Suite (Doc’s, Sheets, Drawings, Forms, etc.)
- All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment.
- Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.
- This is a term-limited position with funding through February 29, 2028. Successful candidates will sign a Waiver of Retention Rights and normal personnel rules regarding retention will not apply. Additional information regarding term-limited positions can be found here .
An applicant who has been removed from an employment list or removed from consideration during the selection process may request a review by the State Personnel Director.
As an applicant directly affected by the results of the selection or comparative analysis process, you may file a written appeal with the State Personnel Director.
Review of the completed, signed and submitted appeal will be timely on the basis of written material submitted by you, using the official appeal form signed by you or your representative. This form must be completed and delivered to the State Personnel Board by email at dpa_state.personnelboard@state.co.us within ten (10) calendar days from your receipt of notice or acknowledgement of the Department’s action.
For further information on the Board Rules, you can refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov/board-rules .
Supplemental Information
How to Apply (PLEASE READ CAREFULLY)
Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.
Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.
Comparative Analysis Process
The comparative analysis process will consist primarily of a review of applications against the minimum and preferred qualifications of this position. Applications will be reviewed in comparison to all others in the applicant pool in order to identify a top group of candidates who may be invited for a final interview. Depending on the size of the applicant pool, additional selection processes may be utilized to identify a top group of candidates. Applicants will be notified of their status via email.
Failure to submit properly completed documents by the closing date will result in your application being rejected.
ADAAA Accommodations : The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.
The Department of Health Care Policy & Financing is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Anupreet Kaur, at anupreet.kaur@state.co.us .
The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.