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. What you’ll do: • 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 to 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
