Eligibility Specialist

Employment Type: Full-time

Location Type: Hybrid Home

Salary: [Not Specified]

Position Overview

Become a part of our caring community and help us put health first! Join our outstanding team at Inclusa/Humana as an Eligibility Specialist. In this important role, you will collaborate closely with members and their support networks, offering expert guidance and education on eligibility requirements and member financial responsibilities related to Medicaid and Family Care. This position provides a meaningful opportunity to make a positive impact through your knowledge and support.

Responsibilities

The Eligibility Specialist is responsible for determining medical and health-related expenses that are allowed per contract to reduce member financial obligations to the organization. This includes:

• Contacting members, guardians of estates, financial power of attorneys, or representative payees to inform and educate on expenses that are allowed as deductions when determining the amount, if any, a member may need to pay towards their cost of care.
• Verifying, documenting, and reporting allowable member expenses to the appropriate internal and external parties.
• Assisting members and colleagues with their individual questions and/or concerns via phone, secure email, letters, etc.
• Providing education to members and legal decision-makers on requirements for Medicaid and Family Care.

Use your skills to make an impact!

Required Qualifications

• Associate's degree
• Proficiency in Microsoft Word, Excel, and Outlook
• 2 or more years of experience in eligibility requirements for Family Care and/or Medicaid.
• Must reside in the state of Wisconsin.

Preferred Qualifications

• Bachelor's degree

Workstyle & Environment

• Workstyle: Hybrid Home
• Home Office Environment: Your primary work location will be your home office, where the majority of your work week will be spent. You will use Humana office space occasionally for collaboration and other face-to-face needs.
• Typical Work Days/Hours: Monday – Friday, 8:00 am – 4:30 pm CST
• Dedicated Workspace: You must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required.

• Wireless, wired cable, or DSL connection is suggested.

• Satellite, cellular, and microwave connections can be used only if approved by leadership.

• Internet Expense Reimbursement: Employees who live and work from Home in California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Telephone Equipment: Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time, and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

Application Instructions

• HireVue: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
• SSN Alert: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application.