Eligibility Specialist II

SUPERVISION EXERCISED AND RECEIVED

Incumbents in the Eligibility Specialist I and II classifications typically receive supervision from an Eligibility Supervisor and may receive lead direction from an Eligibility Specialist III.

• Performs interactive interviews to elicit eligibility information, obtain and/or verify financial, employment, tax and personal demographic information and determine eligibility for public assistance programs and services
• Analyzes financial and eligibility information to determine initial or continuing eligibility for multiple aid programs
• Explains regulations, rules and policies to clients and apprises them of their rights, responsibilities and eligibility for participation in various public assistance programs and services
• Ensures accuracy and completion of application and declaration forms
• Resolves discrepancies by securing documentation, medical records and confirmation from other agencies
• Enters and retrieves numerical and narrative data and issues benefits from an automated computer system
• Determines the level of benefits to which the client is entitled by making complex computations and/or computer entries and then analyzing the results
• Reviews and interprets information provided on a variety of forms both by the client and third parties to assist with eligibility determination
• Evaluates clients for and answers questions on Advanced Payment Tax Credits (APTC) related to health care reform
• Explains a variety of plan options, costs and individual plan features through Covered California
• Monitors on‑going eligibility by obtaining periodic updated information of eligibility factors and takes appropriate actions on changes
• Determines need for additional services and makes referrals as needed for employment and other services to outside agencies to assist clients toward self‑sufficiency and directs clients accordingly
• Organizes and prioritizes caseload so that necessary case records and documents are processed and updated within specific time limits established by regulation and local policy
• Enters and maintains case records, including written narratives, forms and computer documents in a clear and readable format
• Troubleshoots task and/or case issues to determine appropriate resolution of problems, involving Help Desk as needed
• Communicates both orally and in writing with clients and others related to the initial and ongoing eligibility determination while maintaining confidentiality
• Responds to questions and complaints of clients in person, by telephone, mail and/or email communication
• Provides pertinent forms and pamphlets to clients as required
• Identifies suspected fraud and makes referrals for investigation
• Makes referrals to social service workers as needed
• Participates in special projects, studies, work assignments and committees
• Prepares correspondence and reports
• Performs related duties as assigned

Note:

The level and scope of the knowledge and skills listed below are related to job duties as distinguished between the two levels in the Definition section.

• General goals and purpose of public social services programs
• Laws, rules, regulations, policies and procedures governing eligibility for diverse public assistance programs and related case administrative techniques
• Methods and techniques of conducting an investigative interview and information gathering
• Computer terminology and computer keyboard arrangement
• Modern office practices, methods and procedures
• Record keeping practices and procedures
• Principles of mathematical calculations
• Intricacies of health insurance plans, medical health plan options and associated terminology
• Regulations and rules regarding household filing status related to the Affordable Care Act
• Cultural and human behavior, including knowledge of self, to interact effectively with clients and staff
• Principles and practices of effective customer service
• Structure and content of the English language including the meaning and spelling of words, rules of composition and grammar
• Modern equipment and communication tools used for business functions and program, project and task coordination
• C…