Appeals Clerk (EAOS)

Description & Requirements

This position provides administrative support for the Eligibility Appeals Operations Support (EAOS) Project.

Essential Duties and Responsibilities:

- Maintain journals or subsidiary ledgers of an accounting system and balances and reconciles accounts.

- Conformance with requirements and technical soundness of completed work are reviewed by the supervisor, or are controlled by mechanisms built into the accounting processes.

• Issue informal resolution based on review of an appeal case by obtaining information from various resources, including utilization of the Income Verification Tool/calculator

• Analyze appeals data using federal and/or state laws and regulations along with technical direction, guidance, tools and standard operating procedures provided by unit or client

• Contact the appellant for more information and to clarify questions

• Find any errors during completion of template and correct errors to ensure timely processing Provide telephone outreach to the appellants to explain the results of the IR determination and respond to inquiries based on the standard procedure/process

• Initiate and terminate pended benefits coverage to determine the appellant's eligibility during the adjudication of the appeal.

• Utilize the Marketplace Change Utility to update appellant applications using information and documentation collected during the appeal process.

• Use specialized tools for complex effectuation scenarios to ensure proper allocation of subsidies.

• Perform other functions as requested by management within scope of level or provide occasional support of lower level functions as business and volume needs require

• Receive inbound calls, transferred from the Call Center, to schedule hearings for appellants/authorized representative who did not receive their desired outcome through the Informal Resolution Process.

• Review appeals to verify that an Informal Resolution was issued and confirm that the appellant/authorized representative is dissatisfied with the informal resolution.

• Review the appeal for Language Assistance and Accommodation requests to ensure the proper timeframe allotment for the hearing.

• Complete an Urgency Determination Tool to determine scheduling priority.

• Discuss appellant/authorized representative preferences regarding availability for a hearing.

• Track available timeslots in which a hearing can be scheduled.

• Provide the appellant/authorized representative with the date/time of their scheduled hearing, update scheduling information in EACMS, and issue a Notice of Hearing confirming the date/time of the scheduled hearing.

• Other scheduling related duties as assigned.

Home Office Requirements:

- Internet speed of 25mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)

- Minimum 5mpbs upload speed

- Connectivity to the internet via either Wi-Fi or Category 5 or 6 e...