Eligibility Specialist II

CalHR•Sutter Creek, CA

8d•Onsite

About The Position

The Eligibility Specialist II is the journey-level classification in the Eligibility Specialist series. The position determines applicants’ and recipients’ eligibility for public assistance programs through interactive interviewing and fact gathering; maintains current knowledge of program regulations and procedures for administering multiple-program caseloads; initiates and processes casework through automated systems; identifies needs and makes appropriate referrals for health, social, and employment services; and performs related work as required. Incumbents demonstrate working knowledge of eligibility regulations, procedures, and eligibility software systems, and independently handle more complex tasks and/or caseloads, consulting Eligibility Specialist IIIs or Eligibility Supervisors as needed. Positions are flexibly staffed and are normally filled by advancement from the lower level. External candidates must have prior experience as an Eligibility Specialist, Eligibility Worker, or in a comparable position. This is an in-person position; telework is not available. Incumbents typically receive supervision from an Eligibility Supervisor and may receive lead direction from an Eligibility Specialist III. The role involves determining initial and ongoing eligibility for multiple assistance programs, explaining program and health coverage options, maintaining timely and accurate case records, and connecting clients with appropriate services.

Requirements

One year of full-time experience in an Eligibility Specialist I classification in an Interagency Merit System (IMS) County; or two years of full-time experience determining eligibility for public assistance programs in a public human services agency.
Working knowledge of public social services programs; laws, rules, regulations, policies, and procedures governing eligibility; and related case-administration techniques.
Knowledge of investigative interviewing and information-gathering methods, computer terminology, recordkeeping, mathematical calculations, health insurance plans, Affordable Care Act household filing rules, customer service, English composition and grammar, modern office practices, and business communication tools.
Ability to apply County Social Services Department policies and procedures and eligibility rules for multiple public assistance programs.
Ability to gather and verify eligibility information, conduct in-depth interviews, analyze information from multiple sources and electronic systems, and determine appropriate action, including in emergencies.
Ability to make referrals, detect and evaluate potential fraud, and assess and manage difficult or hostile situations or call for intervention when appropriate.
Ability to enter and maintain accurate, timely data; navigate computer systems and software; identify and correct inaccurate computer output; and process cases manually when required.
Ability to organize caseloads and meet strict deadlines amid changing requirements.
Ability to interpret and explain detailed correspondence, reports, regulations, policies, program rules, health insurance options, and tax-credit implications to people from diverse backgrounds.
Ability to perform mathematical computations accurately and rapidly; evaluate tax filing information and documents; and prepare clear, accurate records and reports.
Ability to communicate clearly and courteously orally and in writing, establish cooperative working relationships, and follow written and oral directions.
Ability to work in a fast-paced professional office environment and prioritize duties with varying time requirements.
Essential personal qualifications include integrity, initiative, dependability, good judgment, and the ability to work cooperatively; health must be consistent with performing assigned duties.
Applicants must be authorized to work in the United States without visa sponsorship by the start date of employment.

Nice To Haves

Ability to speak, read, and write Spanish in addition to English is an asset but is not required.
A valid driver’s license may be required at appointment.

Responsibilities

Conduct interactive interviews to obtain or verify financial, employment, tax, and demographic information and determine eligibility for public assistance programs and services.
Analyze financial and eligibility information to determine initial or continuing eligibility for multiple aid programs.
Explain program regulations, rules, policies, client rights, responsibilities, and eligibility for participation in assistance programs and services.
Ensure application and declaration forms are accurate and complete.
Resolve discrepancies by obtaining documentation, medical records, and confirmation from other agencies.
Enter and retrieve data and issue benefits through automated computer systems.
Determine benefit levels through complex calculations, computer entries, and analysis of results.
Review and interpret information on forms completed by clients and third parties.
Evaluate clients for and answer questions about Advanced Payment Tax Credits (APTC) related to health care reform.
Explain Covered California plan options, costs, and plan features.
Monitor ongoing eligibility, obtain updated information, and take appropriate action when eligibility factors change.
Identify needs for additional services and make referrals to employment services, social service workers, and other agencies or community programs.
Organize and prioritize caseloads to meet regulatory and local-policy deadlines.
Maintain clear and readable case records, narratives, forms, and computer documents.
Troubleshoot task and case issues and involve the Help Desk as needed.
Communicate with clients and others about eligibility determinations while maintaining confidentiality.
Respond to client questions and complaints in person, by telephone, mail, or email.
Provide clients with pertinent forms and pamphlets.
Identify suspected fraud and refer cases for investigation.
Participate in special projects, studies, work assignments, and committees.
Prepare correspondence and reports.
Perform related duties as assigned.