What are the responsibilities and job description for the Eligibility Specialist position at State of Washington?
Description
The mission of Washington Health Benefit Exchange (Exchange) is to radically improve how Washington residents secure health insurance through innovative and practical solutions, an easy-to-use customer experience, our values of integrity, respect, equity and transparency, and by providing undeniable value to the health care community.
The Exchange is a public-private partnership that operates Washington Healthplanfinder, the eligibility and enrollment portal used by one in four Washington residents to obtain health and dental coverage. Through this platform, and with support from a Customer Support Center and statewide network of in-person navigators and brokers, individuals and families can shop, compare and enroll in private, qualified health plans (as defined in the Affordable Care Act) or enroll in Washington Apple Health, the state Medicaid program.
The Exchange embraces the following equity statement adopted by our Board of Directors:
Equity is fundamental to the mission of the Washington Health Benefit Exchange. The process of advancing toward equity and becoming anti-racist is disruptive and demands vigilance to dismantle deeply entrenched systems of privilege and oppression. While systemic racism is a root cause of many societal inequities, we must also use an intersectional approach to address all forms of bias and oppression, which interact with and often exacerbate racial inequities. To be successful, we must recognize the socioeconomic drivers of health and focus on people and places where needs are greatest. As we listen to community, we must hold ourselves accountable to responding to recommendations to remedy inequitable policies, systems, or practices within the Exchange’s area of influence. Our goal is that all Washingtonians have full and equal access to opportunities, power and resources to achieve their full potential.
Summary
The Washington Health Benefit Exchange (Exchange) receives thousands of applications for health insurance coverage each day via Washington Healthplanfinder. Using facts, discretion, and independent judgment, this position makes qualitative decisions regarding legal and regulatory compliance with the Affordable Care Act (ACA) by determining coverage and/or subsidy eligibility for customers who applied for health insurance through Healthplanfinder. This includes reviewing documentation to verify citizenship, lawful presence, tribal enrollment, incarceration status, social security number, eligibility for other minimum essential coverage (MEC), and income attestations(s). The incumbent must determine the customer's eligibility for tax credits and/or enrollment in a qualified health or dental plan in accordance with the ACA, regulations, laws, policies, and established business processes. In addition, the incumbent will be expected to actively participate in quality assurance checks of eligibility rules, policies, guidance, and processes in our efforts to achieve continuous improvement.
Duties
Required:
APPLICATION INSTRUCTIONS
This position will be open until we find a suitable number of candidates to review. If interested, please submit an application (CLICK LINK) as soon as possible. The Exchange reserves the right to close the recruitment at any time.
SALARY INFORMATION
Full Salary Range: $56,907.00 to $85,361.00 annually, with midpoint at $71,134.00.
Hiring Range: $65,443.00 and $71,134.00 annually. This is an estimate of where a qualified candidate can expect to receive an offer.
The actual salary offer will consider candidate experience, skills, qualifications, internal equity, and the market. Our compensation policy reserves the salary range above the midpoint for employees who are meeting and exceeding expectations and for growth and development, up to the maximum.
Benefits
Take a peek at our benefits package.
WORKING CONDITIONS
Core business hours are 8:00 a.m. to 5:00 p.m., Monday through Friday. There are times where irregular hours will be required. The preferred duty station is our Olympia, Washington headquarters. The nature of this role relies heavily on remote and in-person collaboration. While a hybrid remote and on-site schedule may be considered, the position will require flexibility to allow for in-office availability as business needs dictate. Travel requirements will be limited, however there may be occasions where an employee is required to travel and work irregular hours to attend meetings or trainings. Duties of this position require the use of standard office furniture and equipment, including setup for remote work. The employee is responsible for providing and maintaining a safe, ergonomic, and secure workspace at their remote location.
The working conditions and physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Special Requirements
A criminal background screen will be conducted for candidates under final consideration, and if hired, every five years of employment where highly sensitive data is processed or maintained by the position. The result of this background screen must meet the Exchange’s eligibility standards.
Other Information
The above statements are intended to describe the general nature and levels of work being performed. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills of personnel so classified.
This is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.
The Washington Health Benefit Exchange is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, marital status, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
We participate in E-Verify. You can view the Department of Justice's Right to Work poster here.
More than Just a Paycheck!
Employee benefits are not just about the kind of services you get, they are also about how much you may have to pay out of pocket. Washington State offers one of the most competitive benefits packages in the nation.
We understand that your life revolves around more than just your career. Like everyone, your first priority is ensuring that you and your family will maintain health and financial security. That's why choice is a key component of our benefits package. We have a selection of health and retirement plans, paid leave, staff training and other compensation benefits that you can mix and match to meet your current and future needs.
Read About Our Benefits
The following information describes typical benefits available for full-time employees who are expected to work more than six months. Actual benefits may vary by appointment type or be prorated for other than full-time work (e.g. part-time); view the job posting for benefits details for job types other than full-time.
Note: If the position offers benefits which differ from the following, the job posting should include the specific benefits.
Insurance Benefits
Employees and their families are covered by medical (including vision), dental and basic life insurance. There are multiple medical plans with affordable monthly premiums that offer coverage throughout the state.
Staff are eligible to enroll each year in a medical flexible spending account which enables them to use tax-deferred dollars toward their health care expenses. Employees are also covered by basic life and long-term disability insurance, with the option to purchase additional coverage amounts.
To view premium rates, coverage choice in your area and how to enroll, please visit the Public Employees Benefits Board (PEBB) website. The Washington Wellness program from the Health Care Authority works with PEBB to support our workplace wellness programs.
Dependent care assistance allows the employee to save pre-tax dollars for a child or elder care expenses.
Other insurance coverage for auto, boat, home, and renter insurance is available through payroll deduction.
The Washington State Employee Assistance Program promotes the health and well-being of employees.
Retirement And Deferred Compensation
State Employees are members of the Washington Public Employees' Retirement System (PERS). New employees have the option of two employer contributed retirement programs. For additional information, check out the Department of Retirement Systems' web site.
Employees also have the ability to participate in the Deferred Compensation Program (DCP). This is a supplemental retirement savings program (similar to an IRA) that allows you control over the amount of pre-tax salary dollars you defer as well as the flexibility to choose between multiple investment options.
Social Security
All state employees are covered by the federal Social Security and Medicare systems. The state and the employee pay an equal amount into the system.
Public Service Loan Forgiveness
If you are employed by a government or not-for-profit organization, and meet the qualifying criteria, you may be eligible to receive student loan forgiveness under the Public Service Loan Forgiveness Program.
Holidays
Full-time and part-time employees are entitled to paid holidays and one paid personal holiday per calendar year.
Note: Employees who are members of certain Unions may be entitled to additional personal leave day(s), please refer to position specific Collective Bargaining Agreements for more information.
Full-time employees who work full monthly schedules qualify for holiday compensation if they are employed before the holiday and are in pay status for at least 80 nonovertime hours during the month of the holiday; or for the entire work shift preceding the holiday.
Part-time employees who are in pay status during the month of the holiday qualify for the holiday on a pro-rata basis. Compensation for holidays (including personal holiday) will be proportionate to the number of hours in pay status in the month to that required for full-time employment, excluding all holiday hours. Pay status includes hours worked and time on paid leave.
Sick Leave
Full-time employees earn eight hours of sick leave per month. Overtime eligible employees who are in pay status for less than 80 hours per month, earn a monthly proportionate to the number of hours in pay status, in the month to that required for full-time employment. Overtime exempt employees who are in pay status for less than 80 hours per month do not earn a monthly accrual of sick leave.
Sick leave accruals for part-time employees will be proportionate to the number of hours in pay status, in the month to that required for full-time employment. Pay status includes hours worked, time on paid leave and paid holiday.
Vacation (Annual Leave)
Full-time employees accrue vacation leave at the rates specified in WAC 357-31-165(1) or the applicable collective bargaining agreement (CBA). Full-time employees who are in pay status for less than 80 nonovertime hours in a month do not earn a monthly accrual of vacation leave.
Part-time employees accrue vacation leave hours in accordance with WAC 357-31-165(1) or the applicable collective bargaining agreement (CBA) on a pro rata basis. Vacation leave accrual will be proportionate to the number of hours in pay status, in the month to that required for full-time employment.
Pay status includes hours worked, time on paid leave and paid holiday.
As provided in WAC 357-58-175, an employer may authorize a lump-sum accrual of vacation leave or accelerate the vacation leave accrual rate to support the recruitment and/or retention of a candidate or employee for a Washington Management Service position. Vacation leave accrual rates may only be accelerated using the rates established WAC 357-31-165.
Note: Most agencies follow the civil service rules covering leave and holidays for exempt employees even though there is no requirement for them to do so. However, agencies are required to adhere to the applicable RCWs pertaining holidays and leave.
Military Leave
Washington State supports members of the armed forces with 21 days paid military leave per year.
Bereavement Leave
Most employees whose family member or household member dies, or for loss of pregnancy, are entitled to five (5) days of paid bereavement leave. In addition, the employer may approve other available leave types for the purpose of bereavement leave.
Additional Leave
Leave Sharing
Parental Leave
Family and Medical Leave Act (FMLA)
Leave Without Pay
Please visit the State HR Website for more detailed information regarding benefits.
Updated 01-07-2026
The mission of Washington Health Benefit Exchange (Exchange) is to radically improve how Washington residents secure health insurance through innovative and practical solutions, an easy-to-use customer experience, our values of integrity, respect, equity and transparency, and by providing undeniable value to the health care community.
The Exchange is a public-private partnership that operates Washington Healthplanfinder, the eligibility and enrollment portal used by one in four Washington residents to obtain health and dental coverage. Through this platform, and with support from a Customer Support Center and statewide network of in-person navigators and brokers, individuals and families can shop, compare and enroll in private, qualified health plans (as defined in the Affordable Care Act) or enroll in Washington Apple Health, the state Medicaid program.
The Exchange embraces the following equity statement adopted by our Board of Directors:
Equity is fundamental to the mission of the Washington Health Benefit Exchange. The process of advancing toward equity and becoming anti-racist is disruptive and demands vigilance to dismantle deeply entrenched systems of privilege and oppression. While systemic racism is a root cause of many societal inequities, we must also use an intersectional approach to address all forms of bias and oppression, which interact with and often exacerbate racial inequities. To be successful, we must recognize the socioeconomic drivers of health and focus on people and places where needs are greatest. As we listen to community, we must hold ourselves accountable to responding to recommendations to remedy inequitable policies, systems, or practices within the Exchange’s area of influence. Our goal is that all Washingtonians have full and equal access to opportunities, power and resources to achieve their full potential.
Summary
The Washington Health Benefit Exchange (Exchange) receives thousands of applications for health insurance coverage each day via Washington Healthplanfinder. Using facts, discretion, and independent judgment, this position makes qualitative decisions regarding legal and regulatory compliance with the Affordable Care Act (ACA) by determining coverage and/or subsidy eligibility for customers who applied for health insurance through Healthplanfinder. This includes reviewing documentation to verify citizenship, lawful presence, tribal enrollment, incarceration status, social security number, eligibility for other minimum essential coverage (MEC), and income attestations(s). The incumbent must determine the customer's eligibility for tax credits and/or enrollment in a qualified health or dental plan in accordance with the ACA, regulations, laws, policies, and established business processes. In addition, the incumbent will be expected to actively participate in quality assurance checks of eligibility rules, policies, guidance, and processes in our efforts to achieve continuous improvement.
Duties
- Working knowledge of the Affordable Care Act, Medicaid, the commercial health insurance market, and Federal and State subsidy programs.
- Maintain a working knowledge and understanding of conditional eligibility verification regulations, laws, policies and guidance, and operation of the prescribed computer programs.
- Use and manage multiple complex computer systems and databases simultaneously to make accurate determinations regarding the customer’s lawful presence or citizenship status, income, social security number, incarceration status, tribal enrollment, and access to other, minimum essential coverage.
- Explain complex requirements and federally mandated timelines to customers who have minimal understanding of the ACA, the health insurance landscape, and/or may have limited English language proficiency.
- Validate and reconcile customer-supplied documents against customer attestation.
- Determine whether customer-supplied documentation is acceptable or fails to enable verification of eligibility and send written correspondence to customers notify them of the determination.
- Adhere to changes in Federal regulations, state law, and WAHBE policies that dictate eligibility for job functions and duties.
- Work independently and manage the workload to meet agreed upon timelines, deliverables, and performance measures.
- Perform complex mathematical calculations to validate customer’s attestation of income and/or eligibility and amount of Advance Premium Tax Credits (APTC), cost sharing reductions, and/or Cascade Care Savings.
- Use appropriate template language in routing situations and draft unique letters as necessary to communicate clearly and effectively, written and orally, with coworkers, external partners such as brokers and navigators, and customers. Demonstrate awareness of potential cultural, linguistic, and/or accessibility differences.
- Assist customers in accordance with policies, business processes, laws, and regulations, reporting changes and making corrections to their Healthplanfinder applications when appropriate and in accordance with policies, procedures, business processes, and federal regulations.
- Respond equitably and with cultural sensitivity to complex eligibility questions that are unable to be answered by first and second-level customer service representatives.
- Participate in discussions and offer suggestions to improve conditional eligibility verification and policies.
- Crosstrain and provide back-up support, as needed, to other Eligibility Specialists, Program/Eligibility Coordinator, and Appeals Specialists.
Required:
- High School Diploma or equivalency.
- Two (2) years of experience explaining and applying complex regulations, laws and policies in a state, federal, health insurance or financial industry.
- One (1) year of demonstrated experience performing complex mathematical calculations, and strong attention to detail.
- Working knowledge of health care, health insurance, and Federal and State subsidy eligibility. Recognition and understanding of historical barriers to accessibility, and lasting impacts of inaccessibility.
- Maintain a working knowledge and understanding of conditional eligibility verification regulations, laws, policies and guidance, and operation of the prescribed computer programs.
- Ability to use Microsoft Office Software, including Teams, Outlook, SharePoint, Word, and PowerPoint, as well as complex spreadsheets, to include MS Excel, APTC Calculator and Income Averaging Calculator (or similar standard business tool).
- Understanding of historical, current and ongoing changes in the health care industry and barriers.
- Demonstrated experience working independently, able to manage multiple projects efficiently, adapt to changing workload, and communicate effectively with stakeholders regarding deadlines.
- Demonstrated ability to use tools/information to solve problems. Systematic approach to researching, prior to making determinations, and/or asking for a second opinion if unsure.
- Effective communication oral/written while using appropriate language in routine situations, ability to adapt depending on the receiver and knowledge level. Mindful awareness of potential cultural, linguistic and or accessibility differences.
- Demonstrated experience protecting sensitive information (PII) and maintaining confidentiality.
- Demonstrated ability to communicate effectively with customers and co-workers, both orally and in writing, regarding complex or sensitive information or issues.
- Make accurate, independent assessments and calculations to ascertain validity of submitted documentation.
- Demonstrated experience as a Team player, able to communicate effectively and clearly. Experience utilizing active listening skills.
- Ability to adapt to changing workload and priorities and offer feedback on processing expectations.
- Understanding of the eligibility determination components in the Affordable Care Act and particularly an understanding of advance premium tax credits (APTC).
- Ability to research and apply policies, business processes, and federal regulations as they relate to eligibility.
APPLICATION INSTRUCTIONS
This position will be open until we find a suitable number of candidates to review. If interested, please submit an application (CLICK LINK) as soon as possible. The Exchange reserves the right to close the recruitment at any time.
SALARY INFORMATION
Full Salary Range: $56,907.00 to $85,361.00 annually, with midpoint at $71,134.00.
Hiring Range: $65,443.00 and $71,134.00 annually. This is an estimate of where a qualified candidate can expect to receive an offer.
The actual salary offer will consider candidate experience, skills, qualifications, internal equity, and the market. Our compensation policy reserves the salary range above the midpoint for employees who are meeting and exceeding expectations and for growth and development, up to the maximum.
Benefits
Take a peek at our benefits package.
WORKING CONDITIONS
Core business hours are 8:00 a.m. to 5:00 p.m., Monday through Friday. There are times where irregular hours will be required. The preferred duty station is our Olympia, Washington headquarters. The nature of this role relies heavily on remote and in-person collaboration. While a hybrid remote and on-site schedule may be considered, the position will require flexibility to allow for in-office availability as business needs dictate. Travel requirements will be limited, however there may be occasions where an employee is required to travel and work irregular hours to attend meetings or trainings. Duties of this position require the use of standard office furniture and equipment, including setup for remote work. The employee is responsible for providing and maintaining a safe, ergonomic, and secure workspace at their remote location.
The working conditions and physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Special Requirements
A criminal background screen will be conducted for candidates under final consideration, and if hired, every five years of employment where highly sensitive data is processed or maintained by the position. The result of this background screen must meet the Exchange’s eligibility standards.
Other Information
The above statements are intended to describe the general nature and levels of work being performed. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills of personnel so classified.
This is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.
The Washington Health Benefit Exchange is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, marital status, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
We participate in E-Verify. You can view the Department of Justice's Right to Work poster here.
More than Just a Paycheck!
Employee benefits are not just about the kind of services you get, they are also about how much you may have to pay out of pocket. Washington State offers one of the most competitive benefits packages in the nation.
We understand that your life revolves around more than just your career. Like everyone, your first priority is ensuring that you and your family will maintain health and financial security. That's why choice is a key component of our benefits package. We have a selection of health and retirement plans, paid leave, staff training and other compensation benefits that you can mix and match to meet your current and future needs.
Read About Our Benefits
The following information describes typical benefits available for full-time employees who are expected to work more than six months. Actual benefits may vary by appointment type or be prorated for other than full-time work (e.g. part-time); view the job posting for benefits details for job types other than full-time.
Note: If the position offers benefits which differ from the following, the job posting should include the specific benefits.
Insurance Benefits
Employees and their families are covered by medical (including vision), dental and basic life insurance. There are multiple medical plans with affordable monthly premiums that offer coverage throughout the state.
Staff are eligible to enroll each year in a medical flexible spending account which enables them to use tax-deferred dollars toward their health care expenses. Employees are also covered by basic life and long-term disability insurance, with the option to purchase additional coverage amounts.
To view premium rates, coverage choice in your area and how to enroll, please visit the Public Employees Benefits Board (PEBB) website. The Washington Wellness program from the Health Care Authority works with PEBB to support our workplace wellness programs.
Dependent care assistance allows the employee to save pre-tax dollars for a child or elder care expenses.
Other insurance coverage for auto, boat, home, and renter insurance is available through payroll deduction.
The Washington State Employee Assistance Program promotes the health and well-being of employees.
Retirement And Deferred Compensation
State Employees are members of the Washington Public Employees' Retirement System (PERS). New employees have the option of two employer contributed retirement programs. For additional information, check out the Department of Retirement Systems' web site.
Employees also have the ability to participate in the Deferred Compensation Program (DCP). This is a supplemental retirement savings program (similar to an IRA) that allows you control over the amount of pre-tax salary dollars you defer as well as the flexibility to choose between multiple investment options.
Social Security
All state employees are covered by the federal Social Security and Medicare systems. The state and the employee pay an equal amount into the system.
Public Service Loan Forgiveness
If you are employed by a government or not-for-profit organization, and meet the qualifying criteria, you may be eligible to receive student loan forgiveness under the Public Service Loan Forgiveness Program.
Holidays
Full-time and part-time employees are entitled to paid holidays and one paid personal holiday per calendar year.
Note: Employees who are members of certain Unions may be entitled to additional personal leave day(s), please refer to position specific Collective Bargaining Agreements for more information.
Full-time employees who work full monthly schedules qualify for holiday compensation if they are employed before the holiday and are in pay status for at least 80 nonovertime hours during the month of the holiday; or for the entire work shift preceding the holiday.
Part-time employees who are in pay status during the month of the holiday qualify for the holiday on a pro-rata basis. Compensation for holidays (including personal holiday) will be proportionate to the number of hours in pay status in the month to that required for full-time employment, excluding all holiday hours. Pay status includes hours worked and time on paid leave.
Sick Leave
Full-time employees earn eight hours of sick leave per month. Overtime eligible employees who are in pay status for less than 80 hours per month, earn a monthly proportionate to the number of hours in pay status, in the month to that required for full-time employment. Overtime exempt employees who are in pay status for less than 80 hours per month do not earn a monthly accrual of sick leave.
Sick leave accruals for part-time employees will be proportionate to the number of hours in pay status, in the month to that required for full-time employment. Pay status includes hours worked, time on paid leave and paid holiday.
Vacation (Annual Leave)
Full-time employees accrue vacation leave at the rates specified in WAC 357-31-165(1) or the applicable collective bargaining agreement (CBA). Full-time employees who are in pay status for less than 80 nonovertime hours in a month do not earn a monthly accrual of vacation leave.
Part-time employees accrue vacation leave hours in accordance with WAC 357-31-165(1) or the applicable collective bargaining agreement (CBA) on a pro rata basis. Vacation leave accrual will be proportionate to the number of hours in pay status, in the month to that required for full-time employment.
Pay status includes hours worked, time on paid leave and paid holiday.
As provided in WAC 357-58-175, an employer may authorize a lump-sum accrual of vacation leave or accelerate the vacation leave accrual rate to support the recruitment and/or retention of a candidate or employee for a Washington Management Service position. Vacation leave accrual rates may only be accelerated using the rates established WAC 357-31-165.
Note: Most agencies follow the civil service rules covering leave and holidays for exempt employees even though there is no requirement for them to do so. However, agencies are required to adhere to the applicable RCWs pertaining holidays and leave.
Military Leave
Washington State supports members of the armed forces with 21 days paid military leave per year.
Bereavement Leave
Most employees whose family member or household member dies, or for loss of pregnancy, are entitled to five (5) days of paid bereavement leave. In addition, the employer may approve other available leave types for the purpose of bereavement leave.
Additional Leave
Leave Sharing
Parental Leave
Family and Medical Leave Act (FMLA)
Leave Without Pay
Please visit the State HR Website for more detailed information regarding benefits.
Updated 01-07-2026
Salary : $56,907 - $85,361