Member Benefit Appeals Supervisor

STATE OF COLORADO RESIDENCY REQUIRED AT TIME OF APPLICATION

Envision Yourself Working at HCPF

The State of Colorado strives to create a Colorado for All by building and maintaining workplaces that value and respect all Coloradans through a commitment to equal opportunity and hiring based on merit and fitness. The State is resolute in non-discriminatory practices in everything we do, including hiring, employment, and advancement opportunities.

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

• Reduced college tuition through CSU Global

• Credit Union of Colorado Membership Eligibility

• Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, go to .

Part of the Department’s Policy, Communication, & Administrations Office, the Legal Division exists to support the legal and privacy issues of the Department. The Legal Division is responsible for maintaining the Protected Health Information database that houses information regarding powers of attorney and authorizations, and to identify and control the release of Department records and protect the civil and privacy rights of program recipients under federal and state law, and to evaluate legal issues in the administration of Department programs to ensure compliance with federal and state law. The Legal Division is also responsible for reviewing client appeals and renders the final agency decision and undertakes special projects to provide advice to senior management on the Department's compliance with federal and state law. The Division also provides legal advice and counsel on the Department's contracts and procurement activities.

We are onboarding new employees using a hybrid approach. The Department supports flexible work arrangements. Depending on the business need and description of the position, we have options that range from hybrid to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage.

**Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment.**

Position Overview

The Colorado Department of Health Care Policy & Financing (HCPF) is seeking an experienced legal professional and collaborative leader to serve as the Member Benefit Appeals Unit Supervisor within the Legal Division.

This position plays a critical role in overseeing the Department's member benefit appeals process, ensuring that appeals involving Medicaid medical, dental, and non-emergency medical transportation (NEMT) benefits are handled accurately, efficiently, and in accordance with applicable federal and state laws.

The position serves as both a legal subject matter expert and a supervisor, representing the Department in administrative appeal hearings before the Office of Administrative Courts while providing leadership, guidance, and oversight to the Benefits Appeals Unit staff.

The successful candidate will combine strong legal analysis, sound judgment, and effective leadership skills to manage complex appeals, support staff development, improve operational processes, and contribute to fair, consistent, and legally sound outcomes for the Department and the members it serves.

Administrative Appeals and Legal Representation

• Represent the Department in Medicaid member benefit appeal hearings before the Office of Administrative Courts (OAC).

• Review and analyze appeals involving medical, dental, and non-emergency medical transportation benefits, services, and equipment.

• Conduct legal research and interpret applicable federal and state laws, regulations, and case law.

• Prepare legal motions, statements of case, briefs, evidence packets, responses, and exceptions.

• Evaluate medical records, supporting documentation, and utilization review determinations to assess the merits of appeals.

• Collaborate with medical professionals, Department staff, vendors, providers, and other stakeholders to research and resolve appeals.

• Communicate and negotiate with opposing counsel or member representatives to explore appropriate resolutions before hearings.

• Provide legal guidance to appeals staff and advise members and stakeholders regarding the administrative appeals process.

Supervision and Team Leadership

• Supervise the daily operations of the Benefits Appeals Unit, providing leadership, direction, and support to staff.

• Plan, prioritize, assign, and monitor workloads to ensure timely completion of appeals and compliance with established deadlines.

• Establish performance expectations, evaluate employee performance, and provide ongoing coaching and professional development.

• Develop training materials, operational guidance, and reference documents to strengthen staff knowledge and consistency.

• Oversee recruitment, hiring, employee development, performance management, and other supervisory responsibilities.

• Review staff work products to ensure accuracy, quality, and adherence to applicable legal standards and Department procedures.

• Identify and resolve operational challenges, employee performance concerns, and workplace conflicts.

• Promote a collaborative, accountable, and productive team environment focused on quality service and continuous improvement.

Program Analysis, Strategic Planning, and Process Improvement

• Analyze member appeals data, trends, and outcomes to identify opportunities for operational and program improvements.

• Evaluate existing procedures, policies, and workflows to improve efficiency, consistency, and the member experience.

• Identify potential gaps in benefits, policies, quality, or access and recommend appropriate improvements.

• Prepare reports, findings, and recommendations for leadership regarding appeals outcomes and potential impacts on Department programs.

• Collaborate with internal teams and stakeholders to support policy development, program improvements, and strategic initiatives.

• Develop and update written protocols, operational procedures, and reference materials.

• Participate in special projects and other initiatives supporting the Legal Division and Department priorities.

Current Colorado Law License Required

An active Colorado law license is required due to the position's substantial legal responsibilities, including representing the Department in administrative hearings, conducting legal research, drafting legal documents, interpreting laws and regulations, and providing legal guidance to appeals staff.

Residency Requirement:

This posting is only open to residents of the State of Colorado at the time of submitting your application.

Class Code & Classification Description:

There are two ways to qualify for this position:

Experience Only:

Eight (8) years of relevant experience in administrative law, health policy, regulatory compliance, or litigation in administrative and/or state or district court.

Or

Education and Experience:

Bachelor’s degree from an accredited institution in public health, health administration, public policy, social sciences, or a field of study related to the work assignment and four (4) years of relevant experience in administrative law, health policy, regulatory compliance, or litigation in administrative and/or state or district court.

PREFERRED QUALIFICATIONS

• Prior state experience related to the duties of this position

• Experience in administrative law

• Litigation experience in administrative and/or state or district courts

• Experience leading teams or supervising groups of two or more individuals

DEFINITION OF PROFESSIONAL EXPERIENCE: Professional experience is defined as experience that may include: independent judgment and discretion in performing work duties, a level of specialized knowledge, in-depth work requirements such as data gathering, analysis and interpretation, customer service across a broad range of individuals including key personnel, and/or individual accountability for results.

CONDITIONS OF EMPLOYMENT

• 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.

• Current Colorado Law License: Must possess an active license to practice law in the State of Colorado.

APPEAL RIGHTS:

If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.

An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email (dpa_state.personnelboard@state.co.us), postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed (303.866.5038) within ten (10) calendar days from your receipt of notice or acknowledgement of the department’s action.

For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to ; contact the State Personnel Board for assistance at (303) 866-3300; or 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 under Rules.

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.