- Uses various information sources, electronic tools, and systems provided by the Department to collect, assemble, evaluate, and act upon information provided by applicant/beneficiaries and third parties to make timely eligibility determinations, reviews, and changes of circumstance. Follows policies and procedures for the collection and analysis of applications and documentation and collects additional information for beneficiaries as necessary with the least burden to the applicant/beneficiary as possible. Performs follow-up activities in an efficient and effective manner, using the communication method most appropriate for obtaining outstanding information in a timely manner. Documents all notes and steps clearly and completely for review and hand-off to other specialists.
- In addition to meeting minimum standards for timely determinations in accordance with the Department's EPSM, serves as a subject matter expert and first tier escalation authority for individuals on their team. Provides weekly individualized guidance for up to 4 team members and provides recommendations for the relevant team supervisor for performance evaluations and periodic counseling. Assists new and underperforming team members with developing work improvement strategies.
- Proficient with all processes, policies, procedures, and system updates to ensure that all eligibility determinations, reviews, and changes are completed accurately with satisfactory documentation. Makes accurate determinations as to individual eligibility based on the rules and standards detailed by the department as defined in written performance standards for the relevant type of determination needed. Resolves discrepancies in a timely manner. Follows appropriate escalation processes as outlined in eligibility process documentation. Labels all documentation, records decision and notes clearly and accurately, and in the appropriate systems of record.
- Maintains a professional demeanor and communication style, ensuring that communication and interactions with co-workers, supervisors, and beneficiaries is clear, polite, and concise. Participates in customer service and privacy training and ensures that confidential or private information is maintained in accordance with State and Federal law as articulated through departmental policies and training.
- Attends all mandatory meetings, trainings, and events as directed by supervisory staff and agency leadership. Maintains awareness of and complies with all agency policies, to include privacy, confidentiality, standards of conduct, performance, leave and compensation, vehicle use and travel, and financial controls. Maintains appropriate certification and training to perform emergency management evacuation and shelter duties as necessary. Performs other duties as assigned by supervisory staff and agency leadership.
- Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
- 15 days annual (vacation) leave per year.
- 15 days sick leave per year.
- 13 paid holidays.
- State Retirement Plan and Deferred Compensation Programs.
- Overtime and/or weekend work with Deputy approval.
- Sitting or standing for long periods of time.
- Lifting requirements: 20 lbs.
- Eligibility Specialists must have a familiarity with computers, standard Microsoft Office software, internet browsers, and the ability to read, write, and speak English in a clear and concise manner.
- Must be able to perform basic mathematical computations.
- Eligibility Specialists must be able to work in a professional office environment with a diverse group of teammates and provide excellent customer service either face to face, telephonically or through written communication.
- Eligibility Specialists must be able to learn, retain, and apply information about federal rules and standards for processing Medicaid eligibility determinations.
- Specialists must maintain productive workspaces and must perform tasks in an effective manner to ensure the completeness, accuracy, and timeliness of eligibility determinations.
- Demonstrates high performance standards.
- Yes
- No
- Yes
- No
- Yes
- No
- Yes
- No
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Eligibility Specialist II Team Lead - Columbia, United States - State of South Carolina
Description
Salary: $31, $41,391.00 AnnuallyLocation : Spartanburg County, SC
Job Type: FTE - Full-Time
Job Number:
Agency: Department of Health and Human Services
Division: Eligibility, Enrollment, and Member Services (EEMS)
Opening Date: 04/30/2024
Closing Date: 5/6/2024 11:59 PM Eastern
Class Code:: GA44
Position Number::
Normal Work Schedule:: Monday - Friday (8:30 - 5:00)
Pay Band: Band 4
Hiring Range - Min.: $31,561.00
Hiring Range - Max.: $41,391.00
Opening Date: 04/30/2024
EEO Statement: Equal Opportunity Employer
Agency Specific Application Procedures:: Failure to provide detailed and complete information may result in your application not being referred.
Veteran Preference Statement: South Carolina is making our Veterans a priority for employment in state agencies and institutions.
Job Responsibilities
The Agency's mission is to be boldly innovative in improving the health and quality of life for South Carolinians.
This position is located in Eligibility, Enrollment and Member Service (EEMS) Processing Centers, Spartanburg County.
Are you the One? We are looking for an Eligibility Specialist II Team Lead (LTCW) who is the front-line of beneficiary access to the Medicaid program. This position collects and evaluates documentation from applicants to determine individual and family eligibility for the program. Eligibility Specialists ensure the integrity of the Medicaid program by completing all eligibility determinations, reviews, and eligibility changes in an accurate and timely manner. In addition to meeting minimum standards for timely determinations in accordance with the Department's EPSM, serves as a subject matter expert and first tier escalation authority for individuals on their team.
A high school diploma and experience in customer services, social services, human services, and/or Medicaid processing.
A bachelor's degree may be substituted for the required program experience.
Additional Requirements:
Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.
The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.
Benefits for State Employees
The state of South Carolina offers eligible employees generous benefits, including health and dental insurance; retirement and savings plan options; and paid vacation and sick leave. Plus, work-life balance programs such as telecommuting and flexible work schedules are available to employees of some state agencies.
Insurance Benefits
Eligible employees may enroll in health insurance, which includes prescription coverage and wellness benefits. Other available insurance benefits include dental, vision, term life insurance, long term disability and flexible spending accounts for health and child care expenses.
Retirement Benefits
State employees are also offered retirement plan options, including defined benefit and defined contribution plans. Additionally, eligible employees may elect to participate in the South Carolina Deferred Compensation Program, which is a voluntary, supplemental retirement savings plan offering 401(k) and 457 plan options.
Workplace Benefits
State employees may also be eligible for other benefits, including tuition assistance; holiday, annual and sick leave; and discounts on purchases, travel and more.
Note: The benefits above are available to most state employees, with the exception of those in temporary positions. Employees in temporary grant and time-limited positions may be eligible for all, some or none of these benefits as benefits are associated with each position type. For these positions, contact the hiring agency to determine what benefits may be available.
01
The responses you provide to these Supplemental Questions will be used in combination with your application to determine whether you meet the minimum qualification requirements. Please, thoroughly complete the Education and Work Experience sections of your application and the Supplemental Questions. Failure to provide detailed and complete information will result in your application being rejected. Any misrepresentation or omissions will result in your disqualification from employment and/or termination. You may not submit resumes in lieu of filling out the application or answering the Supplemental Questions. I acknowledge that I have read, understand, and agree with the above.
Do you have a high school diploma/GED or higher?
Do you have experience in customer services, social services, human services, and/or Medicaid processing?
Do you wish to claim Veteran Preference? If yes, you must submit a copy of your DD214 Form with your job application in order to qualify and claim this preference.
How did you hear about this career opportunity?
Required Question
