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Join our team of professionals in this exciting role as an Eligibility Specialist. The role will provide expertise and support on the eligibility requirements and member financial obligations for Medicaid and Family Care. The Eligibility Specialist acts as a liaison between the organization, Income Maintenance (IM) agencies and Aging and Disability Resource Centers (ADRCs) to facilitate timely enrollment and disenrollment of our members. Candidate must live in Wisconsin or a neighboring State.Administering processes related to the enrollment and disenrollment of the organization’s membership.
- Analyze member enrollment information to determine if Medicaid and Family Care eligibility are active and accurately recorded in Forward Health.
- Validate newly enrolled member demographic information.
- Communicate with ADRC receipt of member enrollment.
- Accurately document member enrollment and disenrollment and provide timely notification to internal colleagues and external stakeholders.
- Analyze reports of changes in member situations to determine if the change may result in a member losing eligibility for services.
Providing necessary support to members to ensure ongoing financial eligibility and continued membership.
- Notify member and colleagues of renewals for financial eligibility.
- Provide education to members and legal decision makers on requirements for Medicaid and Family Care.
- Proactively partner with member and their supports to complete applications and obtain verifications required for Medicaid eligibility determination.
- Assists member and colleagues with their individual questions and/or concerns-via phone, secure email, letters etc.
Determining medical and health related expenses that allowed per contract to reduce member financial obligations to organization.
- Contact member, guardian of estate, financial power of attorney or representative payee to inform and educate on expenses that are allowed as deductions when determining the amount, if any, a member may need to pay towards his/her cost of care.
- Verify, document and report allowable member expenses to the appropriate internal and external parties.
Use your skills to make an impact
Required Qualifications
- Associates Degree with two years of experience in eligibility requirements for family care and/or Medicaid.
- Microsoft technical experience in Word, Excel, Outlook
- Must reside within the State of WI
Preferred Qualifications
- Bachelors Degree in Human Services, Social Work, or related field.
Additional Information
- Workstyle: Hybrid Home
- Work Location: Remote within Wisconsin
- Travel: Minimal travel required
- Typical Work Days/Hours: Monday through Friday, 8:00 am – 4:30 pm CST.
WAH Internet Statement
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Benefits
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:
- Health benefits effective day 1
- Paid time off, holidays, volunteer time and jury duty pay
- Recognition pay
- 401(k) retirement savings plan with employer match
- Tuition assistance
- Scholarships for eligible dependents
- Parental and caregiver leave
- Employee charity matching program
- Network Resource Groups (NRGs)
- Career development opportunities
Modern Hire
As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
SSN Alert
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$44,200 - $60,900 per yearDescription of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About us
About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity® which focuses on the belief in everyone, and from that belief, the common good for all is achieved. In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum.About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
