Eligibility Specialist II; Non-MAGI

Eligibility Specialist II (Non-MAGI)

Location:

Localized Eligibility Processing (LEP), Charleston County. In-office role; not telecommute or remote.

• Uses various information sources, electronic tools, and systems provided by the Department to collect, assemble, evaluate, and act upon information provided by applicants/beneficiaries and third parties to make timely eligibility determinations, reviews, and changes of circumstance. Follows policies and procedures for the collection and analysis of applications and documentation and collects additional information for beneficiaries as necessary with the least burden to the applicant/beneficiary as possible.
  
  Performs follow-up activities efficiently, using the most appropriate communication method to obtain outstanding information in a timely manner. Documents all notes and steps clearly and completely for review and hand-off to other specialists.
• Demonstrates proficiency in utilizing all processes, policies, procedures, and system updates to ensure that all eligibility determinations, reviews, and changes are completed accurately with satisfactory documentation. Makes accurate determinations of eligibility based on the rules and standards detailed by the Department and defined in written performance standards. Resolves discrepancies in case determinations or documentation in a timely manner. Follows appropriate escalation processes as outlined in eligibility process documentation.
  
  Labels all documentation, records decisions and notes clearly and accurately in the appropriate systems of record.
• Maintains a professional demeanor and communication style, ensuring that communication and interactions with co‑workers, supervisors, and beneficiaries are clear, polite, and concise. Participates in customer service and privacy training and ensures that confidential or private information is maintained in accordance with State and Federal law as articulated through departmental policies and training.
• Attends all mandatory meetings, trainings, and events as directed by supervisory staff and agency leadership. Maintains awareness of and complies with all agency policies, to include privacy, confidentiality, standards of conduct, performance, leave and compensation, vehicle use and travel, and financial controls. Maintains appropriate certification and training to perform emergency management evacuation and shelter duties as necessary. Performs other duties as assigned by supervisory staff and agency leadership.

• High school diploma and experience in customer services, social services, human services, and/or Medicaid processing. A bachelor's degree may be substituted for the required program experience.
• Familiarity with computers, standard Microsoft Office software, internet browsers, and the ability to read, write, and speak English clearly and concisely.
• Ability to perform basic mathematical computations.
• Can work in a professional office environment with a diverse group of teammates and provide excellent customer service face‑to‑face, telephonically, or through written communication.
• Can learn, retain, and apply information about federal rules and standards for processing Medicaid eligibility determinations.
• Maintains productive work spaces and performs tasks effectively to ensure completeness, accuracy, and timeliness of eligibility determinations.

• Overtime and/or weekend work with Deputy approval.
• Sitting or standing for long periods of time.
• Lifting requirements: up to 20 lbs.
• Occasional overnight travel.
• In‑office role.

• Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
• 15 days annual (vacation) leave per year.
• 15 days sick leave per year.
• 13 paid holidays.
• State Retirement Plan and Deferred Compensation Programs.

The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions), national origin, age (40 or older), disability or genetic information.