Eligibility Specialist II - LTC

Department of Health and Human Services • Portland, OR

17h • Hybrid

About The Position

The Department of Health and Human Services (DHHS) is seeking an Eligibility Specialist II for its Long-Term Care (LTC) Eligibility Unit. This position focuses on MaineCare policy and involves determining initial and continued eligibility for public assistance programs. The role may also include quality control by reviewing eligibility decisions made by others. It operates in a fast-paced environment with high standards for customer service and program accuracy. The Eligibility Specialist gathers sensitive and personal information to make timely and accurate eligibility determinations, requiring strong interpersonal and conflict resolution skills to interact with diverse individuals, potentially in various emotional states.

Requirements

• A four (4) year combination of education, training, and/or progressively responsible experience in a social services setting which demonstrates interviewing and data gathering skills as needed to form basis for judgments in eligibility determinations, claims resolutions, and/or customer service requests.
• OR a Bachelors Degree in Social Services, Business Administration, or other related field.

Nice To Haves

• Strong interpersonal skills
• Strong conflict resolution skills

Responsibilities

• Determine initial and continued eligibility for public assistance programs, with a focus on MaineCare policy.
• Perform quality control work by reviewing eligibility decisions made by others.
• Gather sensitive and personal information to make timely and accurate eligibility determinations.
• Interview clients, obtain and assess all necessary facts, data, supporting information, and documentation pertaining to the application or recertification for public assistance.
• Evaluate information and apply allowable standards and criteria.
• Explain program eligibility requirements, rules, regulations and individual rights and responsibilities to clients and their representatives.
• Review and analyze information for accuracy; identify inconsistencies; request necessary documentation; verify and validate data.
• Answer inquiries and refer clients to various programs.
• Accurately enter data into an automated system and ensure accurate eligibility results.
• Communicate verbally and in writing with clients, co-workers and other agencies.
• Perform intermediate mathematical calculations.
• Maintain confidentiality of all applicant and recipient information.

Benefits

• 13 paid holidays
• 12 days of sick leave
• 3+ weeks of vacation leave annually
• Health Insurance Coverage (State pays 85%-100% of employee-only premiums)
• Health Insurance Premium Credit (Participation decreases employee-only premiums by 5%)
• Dental Insurance (State pays 100% of employee-only dental premiums)
• Retirement Plan (State contributes 14.11% of employee's pay towards MainePERS)
• Six weeks of fully paid parental leave for all employees 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: Mid Level