Medicaid Eligibility Specialist (Hybrid)

Conduent • Albuquerque, NM

3d • Hybrid

About The Position

We’re hiring a Medicaid Eligibility Specialist who reports directly to the Outreach Supervisor. Conducts presentations throughout the community on New Mexico Medicaid Program. Will meet with groups or individuals. Provide accurate information about the New Mexico Medicaid Program and can assist beneficiaries in enrollment and eligibility assistance for potential and existing New Mexico Medicaid beneficiaries. Processes eligibility applications and determines eligibility for the program. Enters eligibility information into a web-based computer system and references other NM-specific databases as appropriate. Follows up with beneficiaries with correspondence, performs file updates as information comes in, and assesses service/information. Your assistance will make a positive difference in the organization you support. You will be able to provide successful administration and resolve inquiries and deliver positive customer experience while meeting performance goals.

Requirements

• Must be 18 years of age or older.
• Have a High School Diploma or an equivalent of education required.
• Must be able to submit to pre-employment screening.
• Have legal authorization to work permanently in the United States without requiring a visa transfer or visa sponsorship.
• Have prior clerical/customer service work experience.
• Comfortable working within established processes and procedures.
• Strong communication and customer service skills
• Reliable attendance and strong work ethic

Nice To Haves

• Strong customer service, communication, and problem-solving skills.
• Experience handling escalated customer concerns and complex issues.
• Positive and energetic attitude.
• Ability to communicate clearly and confidently.
• Ability to multi-task and manage time effectively.
• Attestation to detail, grammar, and spelling accuracy.
• Computer system experience with data entry and database documentation knowledge.

Responsibilities

• Support the research process unit for the SBE (state-based exchange)
• Determine eligibility for NM Medicaid Program according to the NM Medicaid Care regulations/guidelines by reviewing documentation to accurately enter data into a web-based computer system and following procedures for running automated eligibility rules; prepare correspondence for missing information as appropriate; make outbound calls to obtain, clarify, or validate the information.
• Process applications while maintaining an error rate of 5% or below.
• Assist in the call center when needed.
• Work independently on projects.
• Assist/train new staff when needed.
• Maintain good attendance and punctuality.
• Adhere to changes in policy and procedure.
• Provide clear, complete, accurate, and objective information based on a full understanding of program requirements.
• Build relationships with the community and advocacy groups.

Benefits

• medical, dental, vision
• PerkSpot – Employee discount program.
• Paid time off and holidays.
• Paid training.
• Equipment provided.
• Career growth and advancement opportunities.
• Supportive and inclusive work environment.
• health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED