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.