State Fair Hearing Analyst

The State Fair Hearing (SFH) Analyst plays a critical role in supporting the Medicaid Fair Hearing process by partnering with internal teams, legal counsel, and state regulators. This position is responsible for preparing detailed case analyses, managing hearing requests, and representing the organization in Fair Hearings.

This role requires strong analytical thinking, advanced writing skills, regulatory knowledge, and the ability to work independently in a fast-paced, compliance-driven environment.

Key Responsibilities

• Manage Medicaid State Fair Hearing cases and regulatory complaints across multiple states
• Prepare all legal documentation, including evidence gathering, case analysis, and written summaries
• Develop highly detailed agency summaries and narrative reports with strong technical accuracy
• Intake, track, and document Fair Hearing requests, maintaining organized case files and evidence
• Conduct in-depth research and analysis to support case outcomes and benefit determinations
• Collaborate with Dental Directors, legal teams, Grievances & Appeals staff, and cross-functional departments
• Interface with state regulators, hearing officers, attorneys, and members/enrollees
• Represent the organization during Fair Hearings (telephonically or in person, as needed)
• Ensure consistency and compliance across grievance and appeals processes
• Evaluate current workflows and provide recommendations for process improvements
• Travel to attend Fair Hearings when required

Required Qualifications

• 3+ years of experience in healthcare, preferably within grievances and appeals or regulatory environments
• Strong knowledge of state and federal regulations related to Medicaid and Fair Hearings
• Proven experience managing complex casework and regulatory timelines
• Strong written communication skills with the ability to produce detailed, technical documentation
• Excellent verbal communication and presentation skills
• Ability to manage multiple priorities in a fast-paced, deadline-driven environment
• Proficiency in Microsoft Word, Excel, and PowerPoint

Preferred Qualifications

• Bachelor’s degree in Business, Health Administration, or related field preferred (or equivalent experience)
• Experience working directly with state regulatory agencies and Fair Hearing processes
• Knowledge of dental terminology and clinical documentation (e.g., treatment records, diagnostic forms, progress notes)
• Experience coordinating with legal teams and regulatory bodies