Eligibility Processing Specialist - Medicaid

Conduent•Albuquerque, NM

2d•Hybrid

About The Position

The Eligibility Processing Specialist supports the New Mexico Medicaid Program by conducting community presentations for groups and individuals, providing program information, and assisting current and potential beneficiaries with enrollment and eligibility. The role processes applications, determines eligibility under New Mexico Medicaid guidelines, enters information into web-based systems, and uses relevant state databases. It also follows up with beneficiaries, updates files as documentation arrives, and helps resolve inquiries while delivering a positive customer experience and meeting performance goals. The position supports the state-based exchange research process unit and may assist the call center, work independently on projects, and help train new staff. It reports directly to the Outreach Supervisor. The role is hybrid after training, with four work-from-home days and one office day per week; candidates must live within 50 miles of Albuquerque, New Mexico. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m., with no weekends.

Requirements

Must be at least 18 years of age.
High school diploma or equivalent education required.
Must submit to pre-employment screening.
Must be legally authorized to work permanently in the United States without visa transfer or 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.

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

Conduct community presentations about the New Mexico Medicaid Program and meet with groups or individuals.
Provide accurate program information and assist potential and existing beneficiaries with enrollment and eligibility.
Review documentation and determine eligibility according to New Mexico Medicaid regulations and guidelines.
Enter eligibility data into a web-based computer system, use relevant New Mexico databases, and follow procedures for automated eligibility rules.
Prepare correspondence requesting missing information and make outbound calls to obtain, clarify, or validate information.
Follow up with beneficiaries and update files as information is received.
Support the research process unit for the state-based exchange.
Maintain an application-processing error rate of 5% or below.
Assist in the call center when needed.
Work independently on projects.
Assist with or train new staff when needed.
Maintain good attendance and punctuality and adhere to policy and procedure changes.
Provide clear, complete, accurate, and objective information based on program requirements.
Build relationships with community organizations and advocacy groups.