Eligibility Specialist I

Department of Health and Human Services • Farmington, NM

4d • Hybrid

About The Position

As an Eligibility Specialist I, you’ll play a vital role in connecting Maine residents to the health coverage they need through MaineCare—the state’s largest health insurance program serving lower-income adults, children, older adults, and people with disabilities. In this position, you’ll help people navigate important life situations while ensuring accuracy in determining eligibility. The work is fast-paced, collaborative, and mission-driven with a strong focus on customer service, problem solving, and teamwork. The Department of Health and Human Services (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people. The Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Department also promotes public health, operates two state psychiatric hospitals, and provides oversight to health care providers. The Office for Family Independence (OFI) connects Maine people and families to services and programs that foster health, safety, resilience, and opportunity including MaineCare (Medicaid), the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and other education and career programs.

Requirements

• A two (2) year combination of training, education, and/or experience in a health or human services setting which demonstrates competency in applying policies and rules to make decisions, maintaining and verifying digital records, and/or responding to client requests.
• Strong communication and interpersonal skills are essential as you’ll work with people from diverse backgrounds, with varying needs, and help them navigate complex systems during moments that matter.

Responsibilities

• Evaluate information and apply program standards to accurately determine MaineCare eligibility and benefits.
• Use multiple technology systems to enter, review, and verify eligibility-related data and documentation.
• Clearly explain MaineCare rules, requirements, and decisions to applicants and members—both in writing and over the phone.
• Review and process information received electronically or by mail to ensure completeness and compliance.
• Connect individuals with additional programs and services that may support their health and well-being.

Benefits

• 13 paid holidays
• 12 days of sick leave
• 3+ weeks of vacation leave annually
• Health Insurance Coverage – The State of Maine pays 85%-100% of employee-only premiums
• Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%
• Dental Insurance – The State of Maine pays 100% of employee-only dental premiums
• Retirement Plan – The State contributes the equivalent of 14.11% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS)
• Six weeks of fully paid parental leave for all employees who are welcoming a child—including non-birthing and adoptive parents
• Additional, unpaid leave may also be available, under the Family and Medical Leave Act.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree