Eligibility Specialist

SalesGrove - Cleveland, OH (30+ days ago)

Our client is looking for 10 new Eligibility Specialists to add to their awesome team. As an Eligibility Specialist you will advocate and assist low-income Medicare beneficiaries enrolled in a contracted health plan in the application and eventual requalification for government assistance programs.

This position requires a candidate to project empathy over the phone to gain the applicant’s trust and gain their consent for our client to provide application assistance. This positions will then provide information relating to the program qualifications and program application over the phone, in addition to managing the follow up with government offices that process and adjudicate applications.

Our ideal candidate must have a strong working knowledge of our program qualification requirements spanning 50 states, 3 territories and hundreds of counties specific to Medicaid, Special Needs Programs (SNP), Low Income Subsidy (LIS) and the Medicare Savings Program (MSP).


  • Conducts telephonic outreach activities for members who need to apply or recertify and are potentially eligible for various Medicaid programs including the Medicare Savings Programs.
  • Collaborates with government offices to accurately complete the application and recertification process.
  • Secures documentation for Medicaid/MSP renewal applications if needed for members.
  • Attention to detail by adhering to state requirements and securing supporting documentation.
  • Meets daily, weekly, and monthly production goals. Must also meet quality standards by ensuring proper phone etiquette and adherence to scripts, state regulations, HIPAA compliance, meet ongoing corporate compliance standards, and make accurate and descriptive documentation.
  • Participates as required in operational development programs.
  • Research changes with any state and federal regulatory requirements to adhere to strict compliance of all aspects of Medicare programs and Medicaid Outreach Operations.
  • Demonstrates behaviors, actions, and attitudes that reflect our vision, mission and values.
  • Performs other duties as assigned.


  • Bachelor’s degree or Associate diploma with 2-3 years related experience with direct consumer interaction, telephone experience and Medicare/Medicaid program experience.


  • Demonstrated application of data entry and related computer skills.
  • Strong working knowledge with Microsoft Office programs, and some experience with Excel.
  • Excellent oral communication skills; ability to communicate with elderly individuals and governmental personnel.
  • Strong organizational, analytical, critical thinking and customer service skills.
  • Ability to analyze and interpret governmental program criteria.
  • Ability to manage a fast paced environment.
  • Must be able to navigate through multiple databases/monitors.
  • Minimum typing speed of 45 wpm.
  • Ability to interact and decipher information via telephonic or correspondence inquires.
  • Previous experience with screening for Medicaid eligibility preferred.
  • Previous experience working with Medicare recipients preferred.
  • Strong subject matter expertise and knowledge of all relevant Medicaid regulations, industry standards and best practices preferred.
  • Responds to case discontinuation and or denials by determining the action required which may include Initial application, Reapplication, Consultative case processing and determination of Appeal process.
  • Performs other duties or projects as assigned by manager or team lead.

Job Type: Full-time

Salary: $15.00 /hour


  • High school or equivalent (Required)