Eligibility Specialist I

CalHR•Sutter Creek, CA

8d•Onsite

About The Position

The Eligibility Specialist I is the entry-level classification in the Eligibility Specialist series. The position determines applicants’ and recipients’ eligibility for public assistance programs through interactive interviews and fact gathering, maintains current knowledge of program regulations and procedures, processes casework using automated systems, and identifies needs and makes referrals for health, social, and employment services. Incumbents may have relevant prior eligibility experience, completed initial classroom training as an Eligibility Specialist Trainee, or qualifying education. They may receive classroom instruction before taking on casework and initially work under close supervision while developing the ability to determine eligibility independently and apply complex regulations. With experience, incumbents are expected to handle more complex work and larger caseloads with greater independence. After one year of satisfactory performance, incumbents are expected to progress to Eligibility Specialist II. This is an in-person position; telework is not available. Incumbents typically receive supervision from an Eligibility Supervisor and may receive lead direction from an Eligibility Specialist III.

Requirements

Meet one of the listed minimum-qualification patterns: one year of full-time experience as an Eligibility Specialist Trainee in an Interagency Merit System county; or one year of full-time eligibility-determination experience plus two years of clerical work involving public contact; or two years of full-time eligibility-determination experience; or four years of full-time clerical work involving public contact, interviewing, math computations, form completion, or eliciting information from the public; or graduation from an accredited four-year college or university. Qualifying education and experience may be combined; 15 semester units or 22.5 quarter units equal six months of experience.
Knowledge of public social service program goals; eligibility laws, rules, regulations, policies, procedures, and case-administration techniques; interviewing and information-gathering methods; computer terminology and keyboard layout; office practices; recordkeeping; mathematical calculations; health insurance plans and terminology; Affordable Care Act household filing-status rules; cultural and human behavior; customer service; English grammar and composition; business communication tools; computers and software such as Microsoft applications.
Ability to apply County Social Services Department policies and programs and eligibility laws and regulations; gather, verify, analyze, and interpret information from people, documents, and electronic systems; conduct interactive interviews; identify appropriate actions in emergencies; make referrals; detect potential fraud; enter accurate and timely data; use computer systems and office equipment; correct inaccurate computer output; process cases manually when needed; organize caseloads and meet strict deadlines amid changing requirements; understand and explain complex regulations and correspondence; perform mathematical computations; prepare accurate records and reports; explain programs and health-plan options to people from diverse backgrounds; assess and manage difficult or hostile situations; communicate clearly and courteously; maintain cooperative relationships; and follow written and oral instructions.
Pass the written examination with a minimum rating of 70% to obtain a place on the eligible list.
Possess essential personal qualifications, including integrity, initiative, dependability, good judgment, ability to work cooperatively, and health consistent with performing assigned duties.
Be authorized to work in the United States without visa sponsorship by the employment start date.

Nice To Haves

Ability to speak, read, and write Spanish in addition to English is an asset, but is not required.
A valid driver’s license may be required at the time of appointment.
Relevant prior experience determining eligibility for loans, financial assistance, unemployment or veterans benefits, or publicly or privately funded health, counseling, or social-service programs.

Responsibilities

Conduct interactive interviews to collect and verify financial, employment, tax, and demographic information and determine eligibility for public assistance programs and services.
Analyze financial and eligibility information to determine initial or continuing eligibility for multiple aid programs.
Explain program rules, regulations, policies, rights, responsibilities, and eligibility to clients.
Ensure application and declaration forms are accurate and complete.
Resolve discrepancies by obtaining documentation, medical records, and confirmation from other agencies.
Enter and retrieve data and issue benefits through automated computer systems.
Calculate and determine benefit levels using complex computations or computer entries, then analyze the results.
Review client and third-party forms and information to support eligibility determinations.
Evaluate clients for Advanced Payment Tax Credits (APTC) and answer related questions.
Explain Covered California plan options, costs, and features.
Monitor ongoing eligibility by obtaining updated information and taking appropriate action when eligibility factors change.
Identify needs for additional services and refer clients to employment, social service, and other community agencies.
Organize and prioritize caseloads so records and documents are processed and updated within regulatory and local-policy time limits.
Maintain clear and readable case records, narratives, forms, and computer documents.
Troubleshoot task and case issues and involve the Help Desk when needed.
Communicate with clients and others about eligibility determinations while maintaining confidentiality; respond to questions and complaints in person, by phone, mail, or email.
Provide clients with required forms and pamphlets.
Identify suspected fraud and refer cases for investigation.
Participate in special projects, studies, work assignments, and committees.
Prepare correspondence and reports and perform related duties as assigned.