Eligibility Specialist III

CalHR•Quincy, CA

1d•Onsite

About The Position

The Eligibility Specialist III is the advanced journey/lead-level classification and subject matter expert in the Eligibility Specialist series. Incumbents perform the most complex work and specialized assignments requiring an advanced level of technical knowledge in public assistance programs, departmental processes and caseload/workload administration. Incumbents are expected to independently perform specialized and/or complex duties beyond the journey-level classification of the series. In addition, incumbents may perform help desk functions, provide training to a unit of workers determining eligibility for public assistance and/or serve as a lead worker for less experienced employees. Incumbents demonstrate advanced knowledge of eligibility regulations, procedures and eligibility software systems. Other assignments may include performing quality control and/or quality assurance reviews, participating in early fraud prevention programs, representing the County in administrative appeals and fair hearings and/or performing other specialized assignments and related work as required. The Eligibility Specialist III differs from the Eligibility Supervisor in that the latter directly supervises a unit of Eligibility Specialists. The class of Eligibility Specialist III is distinguished from the Eligibility Specialist II as the latter requires a higher level of supervision and the Eligibility Specialist III is assigned lead specialist duties or special assignments with a greater degree of independent judgment.

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
Principles of training and staff development
Modern office practices, methods and procedures
Record keeping practices and procedures
Principles of mathematical calculations
Intricacies of health insurance plans and 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
Lead, direct and train other eligibility staff
Evaluate and make appropriate recommendations and corrections on selected cases
Determine appropriate course of action in emergency situations
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
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 data accurately 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/workload 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 and 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 IRS 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, both in person, on the telephone, by mail or email communication
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 II classification in an Interagency Merit System (IMS) County; OR Three (3) years of full time experience determining eligibility for public assistance programs in a public human services agency.

Responsibilities

Provides lead direction and/or training to a unit of workers determining eligibility of applicants and recipients for public assistance programs
Provides support to supervisor with unit operations and coverage
Performs interactive interviews to elicit eligibility information, obtain and/or verify financial, employment, tax and personal demographic information and identify need for public assistance programs and services
Assists in the development and implementation of procedures for public assistance programs
Analyzes financial and eligibility information to determine initial or continuing eligibility for multiple aid programs
May provide services to drop-in clients, perform local help desk functions, provide lead direction and training to unit staff and assist with the more complicated cases, or perform specialized assignments in the areas of investigations, quality assurance and control and fair hearings
Explains regulations, rules and policies to clients and apprises them of their rights, responsibilities and eligibility for participation
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 mathematical computations and/or complex computer entries
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/workload so that necessary case records and documents are processed and updated within specific time limits established by regulation and local policy
Completes 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; may participate in system testing and design
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, meetings, conferences and committees
Prepares correspondence and reports
Performs related duties as assigned