Eligibility Specialist I
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. 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. 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.
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.
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
- 3+ weeks of vacation leave annually
- Personal leave for overtime-exempt employees
- 12 days of sick leave per year
- Health insurance coverage (State pays 85%-95% of employee-only premiums)
- Health Insurance Premium Credit (decreases employee-only premiums by 5%)
- Dental insurance (State pays 100% of employee-only dental premiums)
- Retirement Plan (State contributes 14.06% of employee's pay towards MainePERS)
- Gym Membership Reimbursement (up to $40 per month)
- Health and Dependent Care Flexible Spending Accounts
- Public Service Student Loan Forgiveness eligibility
- Living Resources Program (employee assistance program)
- Six weeks of fully paid parental leave for all employees welcoming a child
- Voluntary Deferred Compensation (MaineSaves 457(b) account)
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
