Become a part of our caring community and help us put health first
 

Join our amazing team at Inclusa/Humana in this exciting role as an Eligibility Specialist. The Eligibility Specialist role will provide expertise and support on the eligibility requirements and member financial obligations for Medicaid and Family Care. The Eligibility Specialist acts as a liaison between Inclusa, Income Maintenance (IM) agencies and Aging and Disability Resource Centers (ADRCs) to facilitate timely enrollment and disenrollment of Inclusa members.

Administering processes related to the enrollment and disenrollment of the organization’s membership.

• Analyze member enrollment information to determine if Medicaid and Family Care eligibility are active and accurately recorded in Forward Health.
• Validate newly enrolled member demographic information.
• Communicate with ADRC receipt of member enrollment.
• Accurately document member enrollment and disenrollment and provide timely notification to internal colleagues and external stakeholders.
• Analyze reports of changes in member situations to determine if the change may result in a member losing eligibility for services.

Providing necessary support to members to ensure ongoing financial eligibility and continued membership.

• Notify member and colleagues of renewals for financial eligibility.
• Provide education to members and legal decision makers on requirements for Medicaid and Family Care.
• Proactively partner with member and their supports to complete applications and obtain verifications required for Medicaid eligibility determination.
• Assists member and colleagues with their individual questions and/or concerns-via phone, secure email, letters etc.

Determining medical and health related expenses that allowed per contract to reduce member financial obligations to organization.

• Contact 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.
• Verify, document and report allowable member expenses to the appropriate internal and external parties.

Use your skills to make an impact
 

Required Qualifications

• Associates degree
• Microsoft technical experience in 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:

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

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.

WAH

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 recommended; 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

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflec