Eligibility Processing Specialist - Medicaid
About The Position
Conduent is hiring an Eligibility Processing Specialist to support New Mexico’s Medicaid program. The role conducts community presentations for groups and individuals, provides accurate program information, and helps current and potential beneficiaries with enrollment and eligibility assistance. It processes applications, determines eligibility under New Mexico Medicaid regulations and guidelines, enters information into web-based systems, and refers to other New Mexico databases as appropriate. The specialist follows up with beneficiaries through correspondence and outbound calls, updates files as new information arrives, and assesses service and information needs. The role supports the State-Based Exchange research process unit, assists the call center when needed, works independently on projects, and may train new staff. The position reports directly to the Outreach Supervisor. This is a full-time hybrid position for candidates who reside within 50 miles of Albuquerque, New Mexico. After training, the schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m., with four work-from-home days and one office day each week. The listed pay rate is $19.00 per hour.
Requirements
- Must be at least 18 years of age.
- High school diploma or equivalent education.
- Must be able to submit to pre-employment screening.
- Legal authorization 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
- Experience handling escalated customer concerns and complex issues.
- Strong problem-solving skills.
- 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 for groups and individuals.
- Provide accurate program information and assist potential and existing beneficiaries with enrollment and eligibility.
- Support the State-Based Exchange research process unit.
- Review documentation and determine Medicaid eligibility according to New Mexico regulations and guidelines.
- Enter eligibility data into a web-based computer system 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, update files as information is received, and assess service and information needs.
- Process applications while maintaining an 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 members and advocacy groups.
Benefits
- Medical, dental, and vision benefits from day one for eligible roles.
- PerkSpot employee discount program.
- Paid time off and holidays.
- Paid training.
- Equipment provided.
- Career growth and advancement opportunities.
- Supportive and inclusive work environment.
- Health insurance coverage.
- Voluntary dental and vision programs.
- Life and disability insurance.
- Retirement savings plan.
- Paid holidays and paid time off, vacation, and/or sick time.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
