Eligibility Worker I

CalHR•Madera, CA

12d

About The Position

The Eligibility Specialist I is the entry-level classification in the Eligibility Specialist series. The role determines applicants’ and recipients’ eligibility for public assistance programs through interactive interviews and fact gathering, maintains knowledge of program regulations and procedures, processes casework through automated systems, identifies needs and makes referrals for health, social, and employment services, and performs related work. Incumbents may bring related eligibility experience, have completed initial classroom training in the Eligibility Specialist Trainee program, or meet the required education level. They may receive classroom instruction before taking on casework and initially work under close supervision while learning to make eligibility determinations and apply complex regulations. With experience, incumbents are expected to work more independently, handle more complex tasks and/or larger caseloads, and progress to Eligibility Specialist II after one year of satisfactory performance as an Eligibility Specialist I. The position is in a work team and typically receives supervision from an Eligibility Supervisor; it may also receive lead direction from an Eligibility Specialist III. The role involves assessing eligibility for multiple assistance programs, explaining program rules and health coverage options, maintaining accurate case records, managing a caseload within regulatory deadlines, and communicating with clients and other parties while protecting confidentiality. The listed salary range is $19.44–$23.91 hourly, $3,370.07–$4,144.77 monthly, or $40,440.89–$49,737.20 annually.

Requirements

Meet one of the stated minimum qualification patterns: one year of full-time experience as an Eligibility Specialist Trainee in an Interagency Merit System county; or one year determining eligibility for health programs, loans, financial assistance, unemployment, or other benefits plus two years of clerical work involving public contact; or two years determining eligibility for those programs or benefits; or four years of clerical work involving public contact, interviewing, math computations, completion of forms, or eliciting information from the public; or graduation from an accredited four-year college or university.
Qualifying experience and education may be combined; 15 semester units or 22.5 quarter units count as six months of experience when combining education and experience.
Knowledge of public social services programs; eligibility laws, rules, regulations, policies, and procedures; case administration; interviewing and information-gathering methods; computer terminology; office practices; recordkeeping; mathematical calculations; health insurance plans and terminology; Affordable Care Act household filing-status rules; cultural and human behavior; customer service; English grammar and usage; business communication tools; and computers and software such as Microsoft applications.
Ability to apply county social services policies and eligibility rules; gather and verify information; conduct in-depth interviews; determine actions in emergencies; make referrals; detect potential fraud; analyze information from multiple sources and electronic systems; accurately enter and maintain data; use computer systems and office equipment; correct inaccurate computer output; process cases manually when required; organize caseloads and meet strict deadlines amid changing requirements; interpret and explain complex regulations; perform mathematical computations; prepare clear records and reports; explain programs to people from diverse backgrounds; evaluate tax and household filing information; explain health coverage options and tax-credit implications; manage difficult or hostile situations; communicate courteously and effectively; maintain cooperative working relationships; and follow directions.
Possess integrity, initiative, dependability, good judgment, the ability to work cooperatively with others, and health consistent with performing assigned duties.
Applicants must be authorized to work in the United States without visa sponsorship by the employment start date.

Responsibilities

Conduct interactive interviews to gather and verify eligibility, financial, employment, tax, and personal demographic information.
Analyze financial and eligibility information to determine initial or continuing eligibility for multiple aid programs.
Explain regulations, policies, client rights, responsibilities, and program eligibility.
Ensure application and declaration forms are accurate and complete.
Resolve information discrepancies by obtaining documentation, medical records, and confirmation from other agencies.
Enter and retrieve information and issue benefits using automated systems.
Calculate and determine benefit levels, including through complex computations and computer entries.
Review client and third-party forms to support eligibility determinations.
Evaluate clients for Advanced Payment Tax Credits (APTC) and answer related questions; explain Covered California plan options, costs, and features.
Monitor ongoing eligibility, obtain updated information, and take appropriate action when eligibility factors change.
Identify additional service needs and refer clients to employment, social service, and other outside agencies.
Organize and prioritize caseloads so case records and documents are processed and updated within applicable time limits.
Maintain clear and readable case records, narratives, forms, and computer documents.
Troubleshoot task and case issues and involve the Help Desk when needed.
Communicate orally and in writing with clients and others regarding eligibility while maintaining confidentiality.
Respond to client questions and complaints in person, by telephone, mail, or email.
Provide clients with required 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.