ADRC Elder Benefit Specialist I​/II

Elder Benefit Specialist

This position provides benefits counseling, advocacy, information, advice, and assistance to St. Croix County residents age 60 and older regarding eligibility for and problems with public benefits and services, health care financing, insurance, housing, and other financial and consumer concerns within the Elder Benefit Specialist (EBS) Program benefits scope. The position helps customers understand their rights and options, obtain or maintain benefits, address adverse benefit decisions, and complete appeals when appropriate.

Services promote the autonomy, dignity, independence, and financial security of older adults and are provided in accordance with Wisconsin Stat. § 46.81, the Wisconsin Department of Health Services EBS Program Operations Manual, and applicable state and local policies.

The following duties are normal for this position. These are not to be construed as exclusive or all-inclusive. To perform this job successfully, an individual must be able to perform each duty satisfactorily. Other duties may be required and assigned.

• Handles EBS case intakes and referrals and provides accurate, timely information, advice, benefits check-ups, counseling, and assistance regarding public benefits and services, health care financing, insurance, housing, and other financial and consumer concerns within the EBS Program benefits scope.
• Provides customer-directed advocacy and, when appropriate, direct representation in benefit applications and administrative appeals. Consults regularly with the EBS program attorney for technical assistance, case-merit analysis, advocacy strategy, and referrals for legal representation; follows formal representation requirements when applicable.
• Assists customers with applying for, renewing, obtaining, and maintaining benefits and services within the EBS Program benefits scope, including gathering supporting documentation and completing and submitting appeals. Provides services in the office, in customers' homes or community locations, by telephone, virtually, by email, and through written correspondence, as appropriate.
• Determines EBS service eligibility and applies the EBS Client Services Agreement, case acceptance, prioritization, caseload management, service limitation, case closure, and case termination policies. Distinguishes informational contacts from cases and monitors open cases to move them toward timely resolution.
• Maintains the EBS Program's strict confidentiality standards; obtains informed consent and specific releases when required; protects customer records; and promptly consults the program attorney regarding potential conflicts of interest, suspected fraud, subpoenas, legal requests, elder-abuse reporting considerations, and other issues identified by program policy.
• Maintains complete, accurate, timely, and confidential case files, case notes, Client Services Agreements, supporting documents, and records in the required case-management and reporting systems. Complies with state, federal, SHIP, Medicaid Administrative Claiming, and County reporting requirements, including 100% time and task reporting, and generates records needed for annual case review.
• Develops and maintains in-depth knowledge of benefit programs, laws, regulations, policies, and advocacy strategies. Completes EBS program orientation, initial training, job shadowing, and all mandatory ongoing training required by the program attorney and the Wisconsin Department of Health Services. Completes and maintains State Health Insurance Assistance Program (SHIP) counselor certification as required.
• As assigned, assists with the recruitment, training, and development of EBS program volunteers and ensures volunteers understand their roles and the applicable confidentiality and conflict-of-interest requirements.
• Conducts accessible outreach and community education so older adults throughout the County understand EBS advocacy services and their rights, benefits, and entitlements, including Medicare, Medicaid, Social Security, health insurance, and other topics within the EBS Program benefits scope.
• Develops and distributes accurate informational and outreach materials; provides presentations, workshops, and other community education; submits newsletter or media content; and prepares clear customer and agency correspondence.
• Research benefit laws, policies, and procedures; identifies customer goals, relevant benefits, evidence, deadlines, barriers, and advocacy options; explains the advantages and…