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SalaryThe Service Center Representative - Eligibility Specialist (ES) is responsible for receiving high volume, often back-to-back, inbound calls about Medicaid, Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) programs. ES's will assist customers by answer queries, handling complaints and troubleshooting problems in a professional manner ensuring effective resolution and customer satisfaction. During calls, an ES is expected to also process applications and complete case maintenance activities such as changes to cases in the State eligibility system. Additionally, an ES should ensure all client service issues are resolved in a timely manner and in accordance with stated policies and procedures.
The ES is responsible for taking inbound calls from Medicaid, SNAP, and TANF applicants, recipients, and other members of the community.
Essential Duties and Responsibilities:
- Execute managed care enrollment tasks using the Welfare Management System (WMS).
- Review enrollment concerns through WMS, and other State Medicaid Data systems.
- Assess managed care issues within the State of Health framework and determine subsequent actions.
- Collaborate with local district, State Department Of Health and Enrollment Broker personnel to address managed care issues.
- Adhere to all standards specified for this role as outlined in the corresponding annual performance criteria and bonus template.
- Perform managed care enrollment activities on the Welfare Management System (WMS).
- Review enrollment issues using WMS, eMedNY and other State Medicaid Data systems.
- Evaluate State of Health managed care issues and make next step determinations.
- Interact with local district, SDOH, eMedNY and Enrollment Broker staff to resolve MC issues.
- Meets all standards established for this position as outlined in the corresponding annual performance criteria and bonus template for this position.
- Handles high volume of inbound calls daily, which are often back-to-back, during the scheduled work shift to answer questions regarding the Medicaid, SNAP, and TANF programs.
- Apply State and/or federal eligibility rules for applicant/recipient information assessment.
- Verifies applicant/recipient data through system interfaces.
- Facilitates the fulfillment of caller requests regarding eligibility information via a One Call Resolution approach while maintaining professionalism and empathy.
- Communicates with applicants/recipients while researching and updating cases and documenting calls simultaneously.
- Educates callers on program services and eligibility requirements while demonstrating excellent communication and customer service skills.
- Serve as a liaison with customers regularly to meet program goals and maintain program services and eligibility, fostering positive working relationships.
- Verifies and enters applicant/recipient data into the State's eligibility system and prepares cases for disposition by State Eligibility Consultant.
- Processes cases and takes necessary action on missing information promptly.
- Meet Quality Assurance and performance metrics and stay updated on project and corporate policies.
- Identify and escalate risks to management.
- Attends all meetings and completes all trainings to stay informed on project/position updates.
- Fulfill all performance requirements associated with eligibility processes.
- Perform additional duties as assigned by management.
Minimum Requirements
- High school diploma or GED required and 0-2 years of relevant professional experience required, or equivalent combination of education and experience.
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We're proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.
