The Customer Service 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.

CSRs will assist customers by answer queries, handling complaints and troubleshooting problems in a professional manner ensuring effective resolution and customer satisfaction.

During calls, a Customer Service Rep is expected to also process applications and complete case maintenance activities such as changes to cases in the State eligibility system.

Additionally, an CSR should ensure all client service issues are resolved in a timely manner and in accordance with stated policies and procedures.

The Customer Service rep is responsible for taking inbound calls from Medicaid, SNAP, and TANF applicants, recipients, and other members of the community.

Position Details & Benefits Package :

• Class Start Date : We have two classes : June 26th and June 27th, 2024
• Location : Onsite - Crown Point, IN
• Work Hours : 8 : 00 AM - 4 : 30 PM, Mon-Fri
• Base rate $18.00 / hr.
• Quarterly Bonus opportunity
• 401K with company match
• Paid time off and paid holidays
• Medical, Dental and Vision benefits
• Employee Assistance Program (EAP)
• Employee Wellness and Discount Programs
• Career development and promotional opportunities 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.

Preferred Skills and Qualifications :

• Proven customer support or Client Service Representative experience strongly preferred.
• Ability to handle complex service inquiries via telephone.
• Strong critical thinking and problem-solving skills.
• Moderate difficulty assignments requiring judgment and issue resolution.
• Understanding of work implications and ability to recommend solutions.
• Accurate data entry (40 keystrokes / minute), strong interpersonal skills.
• Positive relationship-building with customers and state eligibility consultants.
• Attention to detail; excellent organizational, verbal, and written communication skills.
• Comfortable in a fast-paced, deadline-oriented environment.
• Capable of executing many complex tasks simultaneously.
• Team player with the ability to work independently.
• Ability to remain stationary for an extended period. Preferred Qualifications :

Last updated : 2024-05-14