Eligibility Specialist Job Description for Resume

Updated on: June 25, 2022
Position Overview

An eligibility specialist is employed by medical services organizations that provide assistance to applicants in obtaining services and financial aid.

Usually, they work with government agencies but may also work in the private sector where insurance and disability coverage for employees is the norm.

Typically, a high school diploma or GED is sufficient to work as an eligibility specialist, but some organizations may require you to possess a bachelor’s degree in human services.

Working as an eligibility specialist means that you will be spending a lot of time interviewing applicants and following up with service providers and agents.

This means that you will need to possess exceptional communication and interpersonal skills, along with a great ability to analyze and gauge certain situations.

In addition to this, you will need to be well-versed in determining if an application has been filled out properly and if all the information in it is accurate.

A huge part of your work will be to handle intake duties to obtain information from applicants and effectively verify it.

Public relations is one of the most important aspects of working as an eligibility specialist, which is why you may need training in it before you tread on this path.

Some of the important duties of an eligibility specialist include:

Eligibility Specialist Job Description for Resume

• Interview applicants to obtain intake information and ensure that this information is properly verified.

• Provide applicants with information on what to expect during the processing of their applications, and ensure that any questions are answered according to protocol.

• Ascertain that applicants are made aware of the requirements of each application processor module and ensure that this information is obtained from them.

• Review eligibility applications to ensure that they are complete and accurate and provide feedback to applicants regarding any additional information needed.

• Determine applicants’ eligibility and submit their applications to federal agencies and private institutions.

• Facilitate appointments and referrals to ensure process expediting and provide resources and materials to applicants to assist them in receiving services.

• Calculate financial documents to determine clients’ eligibility for programs and services.

• Analyze and track applicants’ appointment processes and oversee the maintenance of waitlists.

• Initiate procedures for granting, modifying, denying, or terminating eligibility based on program requirements.

• Research potential financial resources based on each individual applicant’s specific requirements.

• Provide liaison services between different departments to coordinate benefits and services for applicants.

• Write individualized plans of care and coordinate efforts with participating private and public service providers to ensure assistance.