Eligibility Specialist
Eligibility Specialist
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$ 45400 - 61300
1 Vacancy
Job Description
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.The Eligibility Specialist is responsible for determining medical and health related expenses that are allowed per contract to reduce member financial obligations to organization. This includes:
- Contacting member guardian of estate financial power of attorney or representative payee to inform and educate on expenses that are allowed as deductions when determining the amount if any a member may need to pay towards his/her cost of care.
- Verifying documenting and reporting allowable member expenses to the appropriate internal and external parties.
- Assisting member 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
- Associates degree
- Proficiency in Microsoft Word Excel 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
- Bachelors degree
Additional Information
- Workstyle: Hybrid Home: Associates Home office environment is their primary work location where the majority of their work week will be spent but they will use Humana office space occasionally for collaboration and other face-to-face needs
- Typical Work Days/Hours: Monday Friday 8 am 4:30 pm CST
WAH Internet Statement
To ensure Home or Hybrid Home/Office employees ability to work effectively the self-provided internet service of Home or Hybrid Home/Office employees 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 connection can be used only if approved by leadership.
- Employees who live and work from Home in the state of California Illinois Montana or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
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 securityboth 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
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 with instructions on how to add the information into your official application on Humanas secure website.
Travel: While this is a remote position occasional travel to Humanas offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills knowledge experience education certifications etc.Description of Benefits
Humana Inc. and its affiliated subsidiaries (collectively Humana) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits Humana provides medical dental and vision benefits 401(k) retirement savings plan time off (including paid time off company and personal holidays volunteer time off paid parental and caregiver leave) short-term and long-term disability life insurance and many other opportunities.
About us
About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity which focuses on the belief in everyone and from that belief the common good for all is achieved. In 2022 Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum.About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first for our teammates our customers and our company. Through our Humana insurance services and our CenterWell healthcare services we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need when they need it. These efforts are leading to a better quality of life for people with Medicare Medicaid families individuals military service personnel and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race color religion sex sexual orientation gender identity national origin age marital status genetic information disability or protected veteran status. It is also the policy of Humana to take affirmative action in compliance with Section 503 of the Rehabilitation Act and VEVRAA to employ and to advance in employment individuals with disability or protected veteran status and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions including but not limited to recruitment hiring upgrading promotion transfer demotion layoff recall termination rates of pay or other forms of compensation and selection for training including apprenticeship at all levels of employment.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
