Eligibility Processing Specialist - Medicaid

Conduent•Albuquerque, NM

1d•Hybrid

About The Position

The Eligibility Processing Specialist supports New Mexico’s Medicaid program and the state-based exchange (SBE). The role provides information about the New Mexico Medicaid Program through community presentations and individual or group interactions, and assists current and potential beneficiaries with enrollment and eligibility questions. The specialist processes applications, reviews documentation, determines eligibility according to applicable New Mexico regulations and guidelines, and enters information into a web-based system and other relevant New Mexico databases. The position also involves following up with beneficiaries, preparing correspondence, updating files as new information arrives, and assessing service and information needs. The specialist delivers accurate, clear, complete, and objective information, resolves inquiries, and works toward performance goals and a positive customer experience. This role reports to the Outreach Supervisor. It is full-time and hybrid after training, with four work-from-home days and one office day per week. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m.; weekends are not required. Candidates must reside within 50 miles of Albuquerque, New Mexico.

Requirements

Must be at least 18 years of age.
High school diploma or equivalent education required.
Must be able to submit to pre-employment screening.
Must have permanent legal authorization to work in the United States without requiring visa transfer or visa sponsorship.
Prior clerical or customer service work experience.
Comfort working within established processes and procedures.
Strong communication and customer service skills.
Reliable attendance and a strong work ethic.
Must reside within 50 miles of Albuquerque, New Mexico.

Nice To Haves

Strong problem-solving skills.
Experience handling escalated customer concerns and complex issues.
Positive and energetic attitude.
Ability to communicate clearly and confidently.
Ability to multitask and manage time effectively.
Attention to detail and accuracy in grammar and spelling.
Computer system experience, including data entry and database documentation knowledge.

Responsibilities

Support the research process unit for the state-based exchange (SBE).
Determine eligibility for the New Mexico Medicaid Program by reviewing documentation, entering data into a web-based system, and following procedures for automated eligibility rules.
Prepare correspondence requesting missing information and make outbound calls to obtain, clarify, or validate information.
Process applications while maintaining an error rate of 5% or below.
Use processing systems as a seasoned processor and serve as a subject matter expert.
Assist in the call center when needed.
Work independently on projects.
Assist with or train new staff when needed.
Maintain good attendance and punctuality.
Follow changes in policy and procedure.
Provide clear, complete, accurate, and objective information based on program requirements.
Build relationships with community members and advocacy groups.
Conduct community presentations about the New Mexico Medicaid Program and assist beneficiaries with enrollment and eligibility.
Follow up with beneficiaries, update files as information is received, and assess service and information needs.