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Eligibility Specialist Resume Samples
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0-5 years of experience
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.
0-5 years of experience
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.
0-5 years of experience
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.
10+ years of experience
- 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
0-5 years of experience
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.
0-5 years of experience
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
0-5 years of experience
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.
0-5 years of experience
- 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
0-5 years of experience
- 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.
0-5 years of experience
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.
0-5 years of experience
The Eligibility Advisor is responsible for verifying, documenting and coordinating information needed to process beneficiaries through health insurance policy analysis, documentation verification, employer coordination and customer service while ensuring accurate data entry and validation for timely processing.
- Provides enrollment assistance and HIPP program information over the phone to beneficiaries
- Verifies, documents and investigates presence of health care coverage for Medicaid recipients and their families.
- Assists in the identification of beneficiaries that might qualify to have enrollment packages issued in relation to this project
0-5 years of experience
The Eligibility Advisor is responsible for verifying, documenting and coordinating information needed to process beneficiaries through health insurance policy analysis, documentation verification, employer coordination and customer service while ensuring accurate data entry and validation for timely processing.
- Provides enrollment assistance and HIPP program information over the phone to beneficiaries
- Verifies, documents and investigates presence of health care coverage for Medicaid recipients and their families.
- Assists in the identification of beneficiaries that might qualify to have enrollment packages issued in relation to this project
0-5 years of experience
- Responsible for answering inbound customer, payer, and attorney calls related to patient accounting questions for hospitals. Calls are primarily related to accounts with government and non-government insurance however may also be for self-pay and uninsured.
- Handling COB, EOB refunds, and law offices
- Answer the calls timely without drops/abandons.
- Ascertain the reason for the call and assist the caller with their questions, concerns or problems with the focus on first call resolution.
- Verifying different types of insurance and billing
- Requesting itemized billing and UB04
0-5 years of experience
Assess senior clients’ eligibility for the State’s ride free transit program.
- Upload required documents to client’s computerized file.
- Follow-up for client’s eligibility certificate for them to receive their ride free
- Resolve client issues and concerns if not eligible for the program at this time.
- Refer clients to other resources they need or want to participate in.
0-5 years of experience
Establish customer service skills in every call handled.
- Extensive research skills were needed to provided client with accurate information pertaining to case using Tiers and case comments
- Provide weekly coaching’s to agents regarding their call handling
- Met weekly goals to complete 30 or more calls graded per team
- Provide agents with guidance and assistance on how to perform their daily duties as CCR’s
0-5 years of experience
Gathering detailed personal and income based information related to applications for public assistance programs under the Family and Social Services Administrations (FSSA).
- Providing accurate and complete information to state eligibility consultant who will make the eligibility decision for various public assistance programs.
- Reviewing applications submitted, identifying missing required client data and verifications that must be collected in support of the eligibility determination.
- Initiating calls to and responding to calls from clients in the data collection process.
- Reviewing case information and preparing it for case disposition by the state eligibility consultant.
- Explaining forms and program guidelines and answering questions regarding programs to clients.
- Entering data into a navigating through multiple database applications.
- Accurately and efficiently completing tasks with high quality and timeliness.
- Working independently of immediate and continuous supervision.
- Performing related duties as assigned.
0-5 years of experience
- Responsible for gathering information related to applications for public assistance programs.
- Reviewing applications submitted.
- Identifying required client data.
- Verifying data in support of the public assistance eligibility determination.
- Communicating with clients.
- Reviewing case information and preparing it for case disposition by the state eligibility consultant.
0-5 years of experience
- Verify eligibility status, co-pay, and re-certification with Medicaid/Medicare clients.
- Assigned new PCP’s for clients.
- Confirm benefits and authorizations for Primary Care/Mental Health.
- Perform annual and quarterly assessments for all PC enrolled patients for Amida Care members.
- Review and update self pay and denial reports.
- Help develop [company name]’s Medical Internship Program.
0-5 years of experience
- Responsible for gathering information related to applications for public assistance programs.
- Provide information to state eligibility consultant who make the eligibility decision for various public assistance programs including TANF, food Stamps and Medicaid.
- Review applications submitted, identifying required client data and verifications that must be collected in support of the eligibility determination.
- Communicate with clients in the data collection process, reviewing the case information and preparing it for case disposition by the state eligibility consultant.
- Specialization in Nursing Home and Medicaid Disability cases
- Utilization of computer programs ICES and WFMS
0-5 years of experience
- Collect and review patient information to determine patient’s eligibility for Medicaid and charity programs.
- Completion of both on line and paper Medicaid / Disability application.
- Research discrepencies of insurance / registration, as well as benefits verification.
- Serve as direct liason among case management and eligibility.
- Assist the uninsured population with their Market Place application during open enrollment.
0-5 years of experience
Determines initial and continuing eligibility of clients for income maintenance programs
- Interviews clients, explains application procedures and assists
- Assist individuals in utilizing the resources of the division and the community
- Gathers, verifies, evaluates, and enters necessary social financial, and medical information to determine the need and eligibility for public assistance
- Prepares summaries of findings to be used in making determination of eligibility
- Authorizes public assistance based on client circumstances and public assistance program requirements
- Maintains complete and accurate computerized and/or paper records of client eligibility and prepares reports
- Performs a variety of diverse tasks while continuing to maintain
- Explains and interprets agency policy, procedures, and rules
- Presents pertinent information at agency conferences or appeals or hearings
- Refers families, children, adults, or aged receiving assistance to other agencies or community resources
0-5 years of experience
- Knowledgeable of state policies, procedures, & educating clients by phone through inbound/outbound call center interaction
- Determines eligibility for public assistance such as medicaid, food stamps, and tanf by gathering and reviewing income documents, asset statements, & other relevant documents
- Displays strong problem solving skills & ability to make decisions in an independent
0-5 years of experience
- Consistently place 100+ outbound calls daily for client recruitment
- Interview families/youth for determination of eligibility into programs
- Gather required documents, enter clients information into Toolbox
- Prepare clients file for counselor/manager
0-5 years of experience
- Verify Medicaid eligibility through NC Tracks
- Determine coordination of benefits, updating demographics and insurance information
- Review service authorization requests, cross-checking consumer data against weekly report for enrollment
- Process enrollment requests submitted by service providers and care coordination teams
0-5 years of experience
- Determining eligibility for Medicaid services for the Elderly and People with Disabilities
- Documents and gathers information or data
- Verifies case information and explains program benefits and requirements
- Assist in providing information and referral services for clients, providers, agencies and the general public
- Knowledge of agency programs, requirements and policies
- Knowledge of interviewing techniques to obtain highly personal information
0-5 years of experience
- Outbound/Inbound Calls
- Gathering information related to application for public assistance programs
- Reviewing application submitted
- Identifying required client data and verification that must be collected for eligibility determination
- Reviewing case information & preparing it for case disposition by state eligibility consultant
0-5 years of experience
- Receives incoming calls as part of [company name] Access and Information workgroup
- Determine caller eligibility for agency related service and assesses appropriate resources
- Completes an intake and makes referral to agency-designated services
- Completes data entry on Efforts-to-Outcome (ETO) data management
- Schedules client appointments and submits referral to appropriate program
- Receives San Jose clinic patients and assesses eligibility for services using Clinic standards, patient care guidelines, and HIPPA compliance policies
- Secures client signature on all required forms and assigns individual medical card to each clinic patient
- Explains benefits to patients regarding their eligibility
0-5 years of experience
- Interview benefits recipients at specified intervals to certify their eligibility for continuing benefits.
- Compile, record, and evaluate personal and financial data in order to verify completeness and accuracy, and to determine eligibility status.
- Interview and investigate applicants for public assistance to gather information pertinent to their applications.
- Initiate procedures to grant, modify, deny, or terminate assistance, or refer applicants to other agencies for assistance.
- Keep records of assigned cases, and prepare required reports.
- Schedule benefits claimants for adjudication interviews to address questions of eligibility.
- Prepare applications and forms for applicants for such purposes as school enrollment, employment, and medical services.
- Provide applicants with assistance in completing application forms such as those for job referrals or unemployment compensation claims.
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[Eligibility Specialist]
Last edited by: Gabriela Barcenas, CPRW, Content Writer II -
Gabriela Barcenas
CPRW, Content Writer IIGabriela is a Certified Professional Resume Writer (CPRW) and career adviser. With 10 years of digital media experience and five years of resume writing expertise, her publication history includes fashion, education, travel, social justice, equitable design and career advice.
