Eligibility Services Representative

Colorado Access•Denver, CO

3d•Hybrid

About The Position

Colorado Access is seeking an Eligibility Services Representative to process Long Term Care (LTC) applications and support clients seeking health care coverage and services. The representative educates clients about the information needed for timely eligibility determinations, gathers financial and other supporting documentation, assists with applications by phone, mail, and in person, and provides clear guidance on eligibility requirements. The role requires careful review of records, thorough client interviews, and accurate determination of eligibility, including identifying potential periods of ineligibility and possible fraudulent documentation. The representative enters and processes applications in the Colorado Benefits Management System (CBMS), completes case updates and ongoing maintenance, and meets state-mandated processing time frames and department standards for production, quality, and client service. The role coordinates with Single Entry Point agencies, the state disability contractor and Action Review Group when needed, and community providers and facilities. It also handles incoming calls, researches and resolves client questions, documents interactions, and assists customers with Connect for Health Colorado marketplace plan options. Service is available Monday through Friday, 8:00 a.m. to 5:00 p.m., except during office closures or scheduled department training. This is a hybrid position serving Colorado members and communities, with work performed both in-office and remotely. Colorado Access cannot support out-of-state employees. The position is non-exempt and pays $51,600 to $56,240 annually.

Requirements

High school diploma required.
Client service experience and experience determining medical eligibility within CBMS.
One year of experience determining Long-Term Care Medicaid eligibility.
Professional demeanor in face-to-face client interactions and ability to communicate effectively with diverse clients.
Ability to work in a call center environment and respond to inquiries professionally; client service excellence for internal and external clients is required.
Excellent written and verbal communication, problem-solving, attention to detail, and organizational skills.
Ability to work independently in a high-volume environment and manage multiple priorities and projects with tight deadlines when required.
Ability to use the Colorado Benefits Management System (CBMS) to support quality outcomes and resolutions.
Training certification from the Colorado Health Care & Economic Security Staff Development Center, obtainable before or after hire and required within 90 days of employment.
Valid driver’s license and proof of current auto insurance.

Nice To Haves

Associate’s degree in health, social services, or additional college coursework.
Bilingual Spanish/English.
Knowledge of local health and community agencies and providers.

Responsibilities

Process Long Term Care applications and educate clients about information needed for timely eligibility determinations.
Gather income, financial, and other supporting documentation; assist clients with applications by telephone, mail, and in person.
Review eligibility documentation, including bank statements, trust documents, and real estate records, and conduct interviews to verify information and identify possible fraudulent documentation.
Determine periods of ineligibility when client resources have been transferred or given away in the prior five years.
Work with the state disability contractor and Action Review Group, when necessary, to assess whether clients meet the Social Security Administration definition of disability.
Coordinate with Single Entry Point agencies to initiate ULTC100 forms for functional eligibility determinations.
Use CBMS to enter data and process applications accurately while maintaining system security and privacy.
Process applications, case updates, and ongoing case maintenance within state-mandated time frames.
Use policies, procedures, resource materials, databases, and training to maintain accurate, high-quality application processing.
Meet assigned production, quality, and client service standards; attend training and participate in internal and external performance audits.
Assist clients professionally and ethically, following state guidelines and protecting Protected Health Information.
Work with community providers and facilities on client case changes or status, and educate them about program rules and regulations as needed.
Answer incoming calls professionally, research and resolve client inquiries, provide accurate information, and document interactions in the client management system.
Provide client service Monday through Friday, 8:00 a.m. to 5:00 p.m., except during office closures or scheduled department training.
Assist customers and prospective customers with Connect for Health Colorado marketplace health plan options by providing objective information about plans and enrollment resources.

Benefits

Paid time off and floating holidays.
Nine company-paid holidays.
Hybrid work environment.
Employee Assistance Program.
401(k) retirement plan.
Tuition reimbursement, subject to eligibility.
Leadership training, promotion opportunities, performance evaluations, and employee recognition.
Language pay stipend.
Medical, dental, and vision insurance beginning the first day of the month following the start date.
Supplemental critical illness and accidental injury insurance.
Health care and dependent care flexible spending accounts.
Employer-paid basic life insurance and AD&D coverage for employee, spouse, and dependents.
Short-term and long-term disability coverage.
Voluntary life insurance for employee, spouse, and dependents.
Annual bonus program, subject to eligibility, requirements, and performance.