Eligibility Specialist

Humana

2d • Remote

About The Position

Become a part of our caring community Join us at Humana as an Eligibility Specialist, where your passion for supporting members will shine. Reporting to the Supervisor of Care Management Support, you will guide members and their care teams through Medicaid and Family Care eligibility processes, provide direct support with applications and verifications, educate members on program requirements, and assess health-related expenses to help reduce financial obligations. Your strong communication and organizational skills, and your understanding of Medicaid policies, will help you ensure compliance and continuity of care. About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity® which focuses on the belief in everyone, and from that belief, the common good for all is achieved. In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum. About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

Requirements

• 5 or more years of Microsoft Office Suite, Word, Excel, Outlook.
• 1 or more years of experience in eligibility Medicaid, Family Care, or other public assistance programs
• Must reside within the State of WI
• Demonstrated ability to review financial and medical documentation with a high degree of accuracy and attention to detail

Nice To Haves

• Associate or bachelor's degree in a related field
• 1 year of familiarity with CARES, ForwardHealth, and Electronic Case Filing (ECF) system.
• Experience collaborating with Aging and Disability Resource Centers (ADRCs), Income Maintenance (IM) Consortia, and Social Security Administration (SSA)
• Experience working with vulnerable populations, including individuals with disabilities and elderly adults.

Responsibilities

• Notify members and colleagues of financial eligibility renewal requirements.
• Educate members and legal decision-makers on Medicaid and Family Care requirements.
• Assist members and their support networks with completing applications and obtaining necessary verifications for Medicaid eligibility determination.
• Address member and colleague questions by phone, secure email, and written correspondence.
• Assess allowable medical and health-related expenses that can reduce member financial obligations.
• Communicate with members, guardians, financial power of attorneys, or representative payees to inform and educate them on deductible expenses.
• Verify, document, and report allowable member expenses to appropriate internal and external parties.
• Follow professional standards, regulations, and organizational procedures while making informed decisions regarding work priorities and approach.

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees