APPEALS LITIGATION SPECIALIST - 78571

Executive Service APPEALS LITIGATION SPECIALIST Division of TennCare | Member Services | Nashville, TN Minimum Annual Salary: $54,744.00 Closing Date: 07/06/2026 Background Check: This position requires a criminal background check. Who We Are And What We Do TennCare is Tennessee's managed care Medicaid program that provides health insurance coverage to approximately 1.7 million Tennesseans, including pregnant women, children, caretaker relatives, older adults, and adults with physical disabilities. We operate with an annual budget of approximately $19 billion under the oversight of the Centers for Medicare and Medicaid Services (CMS).

Our mission is to improve the lives of Tennesseans by providing high-quality, cost-effective care. We empower our teams to collaborate and improve organizational processes, fostering a workplace where employees find meaning, purpose, and professional development. Job Overview Compensation is equitable and based on education and experience in accordance with Department of Human Resources (DOHR) policy.

TennCare offers a hybrid work environment, combining work from home and in-office days based on business needs. The Appeals Litigation Specialist will resolve appeals prior to hearings, testify on behalf of the Division of TennCare in administrative hearings, and ensure due process standards are met. This role involves documenting actions in TEDS and other systems, and collaborating with management to identify workflow improvements.

Key Responsibilities Maintain a high-volume caseload while adhering to timeliness standards and conducting due process reviews. Contribute to a high-performing, positive work environment aligned with the TennCare mission. Prepare evidence packets and provide testimony as the state's witness during hearings.

Review appeals for potential resolution within policy guidelines; advance cases to hearings when necessary. Demonstrate attention to detail in researching cases and documenting notes. Participate in unit meetings and problem-solving discussions for workflow improvements.

Navigate and utilize the TEDS system effectively. Minimum Qualifications Education and Experience: Bachelor's degree and 5 years of full-time professional experience in social services, human services, auditing, eligibility determination, administrative law, or legal-related areas. Specialized Experience: At least two years of the required experience must be in appeals and hearings or a program-related position involving case evaluation, eligibility, and/or policy.

Substitution: Additional relevant experience may substitute for the required education on a year-for-year basis. Desirable Qualifications Bachelor's degree (preferred in business administration, management, public health, health policy, paralegal, or legal assistant studies). Paralegal Certificate or one year (28 semester hours) of graduate-level law school.

Four (4) years of experience within TennCare, or four (4) years of experience within a Medicaid, managed care, or healthcare organization. An equivalent combination of education and work experience may be considered. Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is committed to fair and equal employment opportunities for all citizens, free from discrimination based on race, color, national origin, age, sex, pregnancy, religion, creed, disability, veteran's status, or any other protected category. #J-18808-Ljbffr