Research and Resolution Specialist

Career Opportunities:
Research and Resolution Specialist (19900)

Posting 19900
-Posted
08/11/2026

- Health & Human Services Comm

- MC Contracts and Oversight

- Business and Financial Operations
- Other Locations (4) - Additional Shifts available (1) -b. $3000 - $4999 per month

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more.

Explore more details on the Benefits of Working at HHS webpage .

Functional

Title:

Research and Resolution Specialist

Job Title: Program Specialist III

Agency: Health & Human Services Comm

Department: MC Contracts and Oversight

Posting Number: 19900

Closing Date: 08/25/2026

Posting Audience: Internal and External

Occupational Category: Business and Financial Operations

Salary Range: $4,020.33-$6,335.66

Pay Frequency: Monthly

Salary Group: TEXAS-B-19

Shift: Day

Additional Shift: Days (First)

Telework:

Travel: Up to 25%

Regular/Temporary: Regular

Full Time/Part Time: Full time

FLSA Exempt/Non-Exempt: Nonexempt

Facility

Location:

Job Location City: AUSTIN

Job Location Address: 701 W 51ST ST

Other Locations: Alamo;
Austin;
Rio Grande City;
San Benito

MOS Codes: 16GX,60C0,611X,612X,63G0,641X,712X,86M0,8U000,OS,OSS,PERS,YN,YNS

Job Description

The Medicaid and CHIP Services (MCS) department is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS’s mission by providing oversight to Managed Care Organizations, which deliver covered services, across delivery models, across all populations served by Medicaid and CHIP, and across all services available to individuals served by our programs.

The Program Specialist will support the Health Plan Management section by conducting in-depth analysis of complex inquiries and complaints and composing written responses to clients, agency staff, providers, advocates and Legislators; interpreting Texas Medicaid/CHIP rules, regulations, policies, and procedures and conducting research to resolve client issues and problems; and coordinating activities between clients and members, health care providers, contractors, advocates and other agencies.

The Program Specialist also evaluates contractor adherence to contracts, policies, procedures, and guidelines; serving as a resource expert, creating and promoting awareness of available Medicaid/CHIP programs other government assistance and programs, and private sector resources. The Program Specialist may review and approve member and provider materials. The Program Specialist identifies policy issues to be initiated, revised or deleted, and makes recommendations for a more effective program.

This position may also support the section by tracking deliverables from Managed Care Organizations (MCOs) and reviewing member and provider communication for approval. Staff in this position must work under limited supervision and with considerable latitude for the use of initiative and independent judgment.

Essential Job Functions (EJFs):

1. Receive, analyze, process and respond to inquiries and complaints pertaining to MCOs. a. Enter complaints and inquiries into the HEARTS tracking system in a timely manner. b. Communicate effective and professionally with the various MCOs and the HHSC staff through resolution.
2. Ensure compliance with contract standards and assess MCO performance relative to the Performance Dashboard or other performance measures and quality improvement goals. a. Populate report templates with information from multiple sources for analysis by staff in the Medicaid/CHIP division. b. On a prompt and regular basis (e.g. quarterly) participate in determining the effectives of MCO operational and contractual compliance by utilizing a standard set of assessment tools and analyzing data.

c. At least annually participate in identification of opportunities for improvement in MCO performance based upon consideration of performance data, stakeholder input, and HHSC priorities. d. Promptly inform the Health Plan Manager of significant MCO compliance and quality improvement issues and provide recommendations for actions. e. Resolve contract performance and compliance issues by working collaboratively with Health Plan Management team, the Health Plan Manager and the MCO to improve performance and contract compliance by participating in the development and monitoring of corrective action plans, as appropriate.

May also participate in the process to assess penalties or damages for failure of the MCO to meet contract performance requirements. f. Review, analyze and provide feedback on MCO materials such as marketing, member and provider materials, within…