Eligibility Specialist II

CalHR•Willows and Orland, CA

1d•Onsite

About The Position

The Eligibility Specialist classifications determine the eligibility of applicants and recipients for public assistance programs through interactive interviewing and fact gathering; maintain current knowledge of program regulations and procedures necessary for multi-program caseload administration; initiate and process casework through automated systems; identify needs and make appropriate referrals for health, social, and/or employment services; and perform related work as required. The Eligibility Specialist II is the journey-level classification in the Eligibility Specialist series. Incumbents demonstrate working knowledge of eligibility regulations, procedures and eligibility software systems. Eligibility Specialist II incumbents handle more complex tasks and/or caseloads independently with consultation as needed by Eligibility Specialist IIIs or Eligibility Supervisors. Positions in this class are flexibly staffed and are normally filled by advancement from the lower level or if filled from the outside, require prior experience as an Eligibility Specialist, Eligibility Worker or comparable position. The class of Eligibility Specialist II is distinguished from the Eligibility Specialist I as the latter requires a higher level of consultation and supervision and is working toward achieving a working knowledge of program rules and regulations. The Eligibility Specialist II class is distinguished from the Eligibility Specialist III in that the latter class is assigned lead specialist duties or special assignments with a greater degree of independent judgment. SUPERVISION EXERCISED AND RECEIVED Incumbents in the Eligibility Specialist I and II classifications typically receive supervision from an Eligibility Supervisor and may receive lead direction from an Eligibility Specialist III.

Requirements

General goals and purpose of public social services programs
Laws, rules, regulations, policies and procedures governing eligibility for diverse public assistance programs and related case administrative techniques
Methods and techniques of conducting an investigative interview and information gathering
Computer terminology and computer keyboard arrangement
Modern office practices, methods and procedures
Record keeping practices and procedures
Principles of mathematical calculations
Intricacies of health insurance plans, medical health plan options and associated terminology
Regulations and rules regarding household filing status related to the Affordable Care Act
Cultural and human behavior, including knowledge of self, to interact effectively with clients and staff
Principles and practices of effective customer service
Structure and content of the English language including the meaning and spelling of words, rules of composition and grammar
Modern equipment and communication tools used for business functions and program, project and task coordination
Computers and software programs (e.g., Microsoft software applications) to conduct research, assess information and/or prepare documentation
Apply the policies, procedures and programs of the County Social Services Department
Apply the laws, rules and regulations governing eligibility and grant determination for multiple public assistance programs and the case administration of these programs
Identify available resources and communicate with others to obtain and verify information concerning eligibility
Use fact finding techniques and perform in-depth and interactive interviewing
Determine appropriate course of action in emergency situations
Make referrals to appropriate agencies and social service programs
Detect and evaluate potential fraudulent situations
Analyze and interpret written, numerical and verbal data from various sources
Utilize multiple electronic information, social services systems and analyze and interpret such information
Enter and maintain data accurately and timely into a computerized system
Navigate through computer screens and effectively use computer systems, software applications and modern business equipment to perform a variety of work tasks
Identify when computer output is incorrect and make corrections
Process cases manually as required
Plan and organize caseload to ensure work is completed in accordance with regulations relating to eligibility and timeliness
Function effectively in a system with strict deadlines and constant changes
Read, understand, apply and explain complicated and detailed correspondence, reports, regulations and policy directives
Perform a variety of mathematical computations accurately and rapidly
Prepare clear, concise and accurate records and reports
Explain complex rules and programs so they can be understood by people of diverse socio-economic, cultural and educational backgrounds
Gather, record and correctly evaluate tax filing data, income and additional necessary information required for the determination of eligibility for one or more programs
Explain health insurance plan options and plan details available to clients through the Affordable Care Act
Review a variety of tax documents to obtain needed household filing information
Explain health care reform tax credit implications to clients
Refer clients to other community services as needed
Assess and manage difficult and hostile persons or situations; or call for intervention when appropriate
Interact with people in a courteous manner in person, on the telephone, by mail or email
Work in a fast-paced, professional office environment and prioritize a wide range of duties with varying time requirements to ensure timely completion
Communicate clearly and concisely, both orally and in writing, using appropriate English grammar and syntax
Establish and maintain cooperative working relationships with the public and staff
Follow written and oral directions and instructions
One (1) year full time experience in an Eligibility Specialist I classification in an Interagency Merit System (IMS) County; OR Two (2) years of full time experience determining eligibility for public assistance programs in a public human services agency.

Nice To Haves

The ability to speak, read, and write Spanish in addition to English would be an asset in this position, but is not required.

Responsibilities

Performs interactive interviews to elicit eligibility information, obtain and/or verify financial, employment, tax and personal demographic information and determine eligibility for public assistance programs and services
Analyzes financial and eligibility information to determine initial or continuing eligibility for multiple aid programs
Explains regulations, rules and policies to clients and apprises them of their rights, responsibilities and eligibility for participation in various public assistance programs and services
Ensures accuracy and completion of application and declaration forms
Resolves discrepancies by securing documentation, medical records and confirmation from other agencies
Enters and retrieves numerical and narrative data and issues benefits from an automated computer system
Determines the level of benefits to which the client is entitled by making complex computations and/or computer entries and then analyzing the results
Reviews and interprets information provided on a variety of forms both by the client and third parties to assist with eligibility determination
Evaluates clients for and answers questions on Advanced Payment Tax Credits (APTC) related to health care reform
Explains a variety of plan options, costs and individual plan features through Covered California
Monitors on-going eligibility by obtaining periodic updated information of eligibility factors and takes appropriate actions on changes
Determines need for additional services and makes referrals as needed for employment and other services to outside agencies to assist clients toward self-sufficiency and directs clients accordingly
Organizes and prioritizes caseload so that necessary case records and documents are processed and updated within specific time limits established by regulation and local policy
Enters and maintains case records, including written narratives, forms and computer documents in a clear and readable format
Troubleshoots task and/or case issues to determine appropriate resolution of problems, involving Help Desk as needed
Communicates both orally and in writing with clients and others related to the initial and ongoing eligibility determination while maintaining confidentiality
Responds to questions and complaints of clients in person, by telephone, mail and/or email communication
Provides pertinent forms and pamphlets to clients as required
Identifies suspected fraud and makes referrals for investigation
Makes referrals to social service workers as needed
Participates in special projects, studies, work assignments and committees
Prepares correspondence and reports
Performs related duties as assigned