Eligibility Specialist Resume Examples

Eligibility Specialist

Interviewed consumers to determine eligibility requirement for Medicaid Insurance, QHP, and suggested referrals to Brokers.

• Assisted consumers by creating online accounts. Various sources used in researching the information necessary to process the applications such as through Access Health, Xerox, Husky Enrollment Center and scanning the internet for Company EIN or calling employers for insurance information.
• Trained consumer knowledge on salary requirements, encouraged employment, and implementation of documents through bar code system.
• Identified case information errors to solve the issues in processing.

Eligibility Specialist

Utilizing knowledge through the understanding of State policies, Medicaid programs and requirements to review redetermination cases assigned by supervisor for the State of Illinois.

• Completing reviews of assigned cases within the required timeframes.
• Gathering documents, inputting information, and calculation income submitted in efforts of making a recommendation to either Continue, Cancel, or Change the status of currently active Medicaid cases.
• Responding to phone calls, written, and electronic inquiries within required timeframes.
• Meet all standards established for position as outlined in the corresponding annual performance criteria and bonus template for specialist.
• Facilitated in expanding 100% [company name] with Illinois Department of Human Services.
• Performs other duties as may be assigned by the Project Manager, Operations Manager or Eligibility Supervisor.

Eligibility Specialist

Provided service and support to a diverse population of families as well as employees in alignment with the policies and procedures of the agency.

• Conducted interviews to determine eligibility for housing assistance through HUD.
• Calculated financial documents to determine monthly housing payments.
• Corresponded with various agencies to assist clients with housing needs.
• Provided clients with timely written correspondence on the status of their housing assistance.

Eligibility Specialist

• Interviewed applicants to determined eligibility for all state Medicaid programs
• Worked with team of 20 to maintain caseload of over 325 customers
• Answered customer questions regarding all Medicaid policy and programs
• Maintained open lines of communications with professional and community resources
• Worked independently in multiple settings with low income families
• Conducted one-on-one training for new staff and co-workers

Eligibility Specialist

Identified, investigated and retrieved suspect products associated with post donation information, donor deferrals, abnormal or unexpected test results, manufacturing issues and notifications from other sources.

• Advised regions, consignees and others to control suspect products using computer notifications, inventory systems, telephone and e-mail systems.
• Responded to and managed in-bound telephone contacts from blood donors and collection staff regarding donor eligibility and concerns.
• Responded to requests from regions and hospitals.
• Maintained Blood Services records in accordance with ARCBS directives and FDA, state and federal regulations.
• Worked in a collaborative team environment in order to meet operational objectives while advancing donor and recipient safety.

Eligibility Specialist

Ensures case information is gathered and processed in a complete and accurate manner in accordance with State policy

• Assists clients with obtaining required verification for determining eligibility for Public Assistance programs
• Works assigned alerts, changes and incoming documents daily
• Counsels clients to accept personal responsibility for their actions, consequences and need to comply with the rules and regulations
• Reviews and processes benefit tasks as a result of appeal requests for the Healthy Indiana Plan

Eligibility Specialist

Interviews clients and obtains and assesses all necessary facts, data, supporting information, and documentation pertaining to the application for public assistance.

• Evaluates information and applies allowable standards and criteria.
• Explains program eligibility requirements, rules, regulations, and individual rights and responsibilities to clients.
• Detects and resolves discrepancies in facts, data, and information provided or revealed.
• Refers clients to various programs.
• Develops reports for, testifies, and represents the Department at fair hearings and fraud hearings.
• Identifies possible benefit overpayments, assesses causes for overpayment, determines whether there has been willful misrepresentation, confronts clients, and negotiates repayments if necessary.
• Examines and evaluates primary and collateral information contained in case records selected for quality control review.

Youth Counselor/eligibility Specialist

• Increase youth participation in the Summer Job League Program
• Enroll and audit participant files for accuracy
• Conducted financial aid eligibility and participant workshops ensuring all program requirements were met
• Assisted with all faucets of employment and training

Eligibility Specialist

• Participating in multidisciplinary teams and meetings regarding, for example, child protection or mental health.
• Encouraging and guiding families in their efforts to become self supporting.
• Ensuring that each person/family that applies for public assistance receives the type and level of assistance that they are eligible for.
• Assessing the needs of each person/family and giving them appropriate information and making any referrals and/or contacts to persons/agencies to help them meet their needs.
• Provided all families with information about the expectations and goals of DHS.

Eligibility Specialist

Perform complex eligibility determinations, assisting in policy creation throughout the process for the Social Security State Supplement Program (SSP)

• Complete demographic and benefit level updates on SSP recipient cases
• Participate in weekly and bi-weekly meetings in which cost-savings measures are decided
• Create policies, procedures, and workflows for eligibility transactions
• Perform Quality Assurance and training duties for recipient eligibility
• Other analysis duties as assigned.