What does an eligibility specialist do?
An eligibility specialist is responsible for reviewing applicants' documents to verify their eligibility for qualifying for various organization programs. Eligibility specialists organize files accurately, communicate with other institutions for fact-checking, follow-up with the applicants for missing requirements, respond to the applicants' inquiries and concerns, and recommend alternatives, especially for financial assistance. An eligibility specialist must have excellent communication and record-keeping skills and extensive knowledge of the aid programs and company policies for processing applications.
Eligibility specialist responsibilities
Here are examples of responsibilities from real eligibility specialist resumes:
- Manage assignments of paying medical bills limit in depth that include organizing and researching regulations as pertain to veterans eligibility.
- Demonstrate competency in basic understanding of Medicaid, policies, forms and DHS policy.
- Coordinate these efforts by working with DES staff, other state agencies, FEMA and other volunteering private organizations.
- Conduct Medicaid and TANF eligibility interviews.
- Interview patients using multiple data base system to assess and determine Medicaid eligibility coverage for long term care services.
- Experience with disability claim process as DHS eligibility worker desire.
- Participate in problem-solving processes and provide vacation/temporary relief as required.
- Document eligibility decisions and enter coded information in DES database.
- Maintain departmental operations in compliance with HIPAA and other regulatory guidelines.
- Participate in problem-solving processes & provide vacation & temporary relief to co-workers.
- Enter updates into company membership database using current industry standards relative to HIPAA guidelines.
- Determine initial and continuing eligibility for the Calfresh program in accordance with establish procedures.
- Determine initial and continuing eligibility for Medi-Cal according to establish procedures and record information for case records.
- Review Medicaid applications with clients, provide information, answer questions and review documentation for adequacy and completeness.
- Interview applicants to obtain financial and other data for initial determination of eligibility and ongoing participation of the TANF program.
Eligibility specialist skills and personality traits
We calculated that 14% of Eligibility Specialists are proficient in Medicaid, Patients, and Provide Technical Assistance. They’re also known for soft skills such as Integrity, Organizational skills, and Communication skills.
We break down the percentage of Eligibility Specialists that have these skills listed on their resume here:
- Medicaid, 14%
Determined eligibility for Medicaid benefits for low-income families, based on State and Federal established policies and guidelines.
- Patients, 11%
Advised patients with benefit and eligibility information by phone and/or internet to determine coverage choices in order to process therapy recommendations.
- Provide Technical Assistance, 6%
Provide technical assistance and orientation to child development teachers and providers.
- Social Work, 5%
Worked directly with county supervisors and social workers to determine clear understanding regarding state statues and mandates relative to reimbursement eligibility.
- Data Entry, 5%
Researched benefits and insurance eligibility, call center environment, highly detailed data entry, followed and maintained HIPAA protocols.
- Community Resources, 4%
Explained eligibility requirements, form completion requirements, community resources for financial assistance, housing opportunities and tenant selection methods.
Common skills that an eligibility specialist uses to do their job include "medicaid," "patients," and "provide technical assistance." You can find details on the most important eligibility specialist responsibilities below.
Integrity. One of the key soft skills for an eligibility specialist to have is integrity. You can see how this relates to what eligibility specialists do because "information clerks, particularly human resources assistants, have access to confidential information." Additionally, an eligibility specialist resume shows how eligibility specialists use integrity: "researched medicare and medicaid integrity status for the state of texas. "
Organizational skills. Many eligibility specialist duties rely on organizational skills. "information clerks must be able to retrieve files and other important information quickly and efficiently.," so an eligibility specialist will need this skill often in their role. This resume example is just one of many ways eligibility specialist responsibilities rely on organizational skills: "participated in the determination of organizational policies regarding process and eligibility for financial assistance for medical costs. "
Communication skills. This is an important skill for eligibility specialists to perform their duties. For an example of how eligibility specialist responsibilities depend on this skill, consider that "information clerks must be able to explain policies and procedures clearly to customers and the public." This excerpt from a resume also shows how vital it is to everyday roles and responsibilities of an eligibility specialist: "explain program guidelines and answer program questions during clients' oral and written communication. ".
Interpersonal skills. A big part of what eligibility specialists do relies on "interpersonal skills." You can see how essential it is to eligibility specialist responsibilities because "information clerks who work with the public and customers must understand and communicate information effectively to establish positive relationships." Here's an example of how this skill is used from a resume that represents typical eligibility specialist tasks: "return phone calls, update computer systems and interact with customers on interpersonal and professional basis. "
The three companies that hire the most eligibility specialists are:
- My Florida Regional Mls17 eligibility specialists jobs
- Florida Department of Transportation13 eligibility specialists jobs
- AppleOne Employment Services5 eligibility specialists jobs
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Compare different eligibility specialists
Eligibility specialist vs. Contact officer
These skill sets are where the common ground ends though. The responsibilities of an eligibility specialist are more likely to require skills like "medicaid," "patients," "provide technical assistance," and "social work." On the other hand, a job as a contact officer requires skills like "loan applications," "credit card," "loan payments," and "tax returns." As you can see, what employees do in each career varies considerably.
Contact officers tend to reach higher levels of education than eligibility specialists. In fact, contact officers are 15.4% more likely to graduate with a Master's Degree and 1.8% more likely to have a Doctoral Degree.Eligibility specialist vs. Employment adjudicator
While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that eligibility specialist responsibilities requires skills like "medicaid," "patients," "provide technical assistance," and "social work." But an employment adjudicator might use other skills in their typical duties, such as, "unemployment insurance," "legal research," "ui," and "state statutes."
Average education levels between the two professions vary. Employment adjudicators tend to reach higher levels of education than eligibility specialists. In fact, they're 9.6% more likely to graduate with a Master's Degree and 1.8% less likely to earn a Doctoral Degree.Eligibility specialist vs. Work force advisor
The required skills of the two careers differ considerably. For example, eligibility specialists are more likely to have skills like "medicaid," "patients," "provide technical assistance," and "social work." But a work force advisor is more likely to have skills like "customer service," "federal regulations," "hhsc," and "processes changes."
Work force advisors typically earn similar educational levels compared to eligibility specialists. Specifically, they're 1.5% more likely to graduate with a Master's Degree, and 0.5% more likely to earn a Doctoral Degree.Eligibility specialist vs. Public housing interviewer
Types of eligibility specialist
Updated January 8, 2025
