Counselor-Enroll/Elig

SGS Consulting; Virginia Beach (VA); Remote; USD 52,000 - 76,000; Full time

Job summary

SGS Consulting in Virginia Beach seeks a Medicaid Eligibility Specialist to process complex cases, assist clients with enrollment, and apply policies accurately. You will work remotely, collaborating with management and training teams, while maintaining precise records and confidentiality.

The role requires high school diploma or GED, 4+ years of relevant experience (or equivalent), and ability to work from Virginia with reliable internet. Bilingual English/Spanish is preferred.

Qualifications

• High school diploma or GED required.
• 4+ years of relevant professional experience or equivalent.
• Associate degree with 2+ years of relevant experience preferred.
• Experience in eligibility, enrollment, healthcare, Medicaid, customer service, or related field preferred.
• Must be able to work remotely from Virginia.
• Reliable wired home internet service required.

Responsibilities

• Process Medicaid eligibility and enrollment cases.
• Assist clients with program connection and eligibility inquiries.
• Research and work on appeals as assigned by supervisors.
• Apply eligibility policies accurately and consistently.
• Serve as SME on eligibility policies and processes for the team.
• Understand and communicate impact on other teams and workflows.
• Track project status, deadlines, deliverables, and due dates.
• Collaborate with project managers on initiatives and projects.
• Provide administrative and operational support for assigned projects.
• Maintain records and documentation related to cases and activities.
• Follow Medicaid policies, procedures, and quality standards.
• Communicate effectively with clients, team members, and management.
• Maintain confidentiality of sensitive client information.
• Meet productivity and attendance expectations during training and work.

Skills

Customer service

Policy understanding

Time management

Communication skills

Remote work

Bilingual English/Spanish

Attention to detail

Research complex cases

MS Office familiarity

Independent & collaborative work

Education

High school diploma or GED

Associate degree preferred

4+ years of relevant experience

Tools

Microsoft Office

Job description

Job Responsibilities:

• Process specialized and complex Medicaid eligibility and enrollment cases
• Assist clients with program connection and eligibility-related inquiries
• Research and work on appeals as assigned by supervisors
• Apply eligibility policies, procedures, and processes accurately and consistently
• Serve as a subject matter resource (SME) on eligibility policies and processes for the team
• Understand and communicate the impact of eligibility processes on other teams and workflows
• Work closely with management and work groups to create and maintain work plan documents
• Track project status, deadlines, deliverables, and due dates
• Collaborate with project managers on various initiatives and projects
• Provide administrative and operational support for assigned projects
• Assist with tracking project progress and identifying outstanding items
• Support the training team during the final week of sandbox training
• Answer questions and provide guidance to new trainees as they transition to their assigned teams
• Maintain accurate records and documentation related to cases, projects, and eligibility activities
• Follow established Medicaid policies, procedures, quality standards, and workflows
• Communicate effectively with clients, team members, supervisors, trainers, and management
• Maintain confidentiality and protect sensitive client information
• Meet established productivity, quality, attendance, and performance expectations

Skills:

• Strong understanding of customer service and client support principles
• Basic computer navigation skills
• Novice-level knowledge of Microsoft Office applications
• Ability to research and process complex cases with attention to detail
• Ability to understand and apply policies, procedures, and eligibility requirements
• Strong organizational and time-management skills
• Ability to track multiple projects, deadlines, and priorities
• Strong written and verbal communication skills
• Ability to work independently and collaboratively in a remote environment
• Ability to learn and apply Medicaid eligibility and enrollment processes
• Strong problem-solving and critical-thinking abilities
• Ability to work effectively with management, project teams, trainers, and colleagues
• Bilingual English/Spanish proficiency preferred/required for bilingual positions
• Ability to maintain consistent attendance throughout training and nesting periods
• Ability to work full-time, 40 hours per week

Education/Experience:

• High school diploma or GED required, with proof of completion
• 4+ years of relevant professional experience required, or an equivalent combination of education and experience
• Associate degree with 2+ years of relevant experience preferred
• Previous experience in eligibility, enrollment, healthcare, Medicaid, customer service, case processing, or a related field preferred
• Must be legally able to work remotely from within the state of Virginia
• Must have reliable traditional wired home internet service; cellular-based internet providers are not permitted
• Minimum internet speed of 25 Mbps download for a single user, 50 Mbps for shared connectivity, and 5 Mbps upload required; 10 Mbps upload preferred
• Must connect the work computer to the internet router using a Category 5 or Category 6 Ethernet cable
• Must be able to provide a screenshot of an internet speed test from Speedtest.net or Google Speedtest upon request
• Must have access to a laptop or computer capable of attending video interviews
• Must be available for the Real Job Preview (RJP), tentatively scheduled for September 23, 2026 and September 30, 2026; exact times to be confirmed
• Must attend RJP sessions on camera
• Must be available for training Monday–Friday, 8:00 AM–4:30 PM EST
• 100% attendance is expected during training and nesting
• No planned time off, late arrivals, or early departures are expected during the training period
• Must be available to work Monday–Friday, 8:00 AM–5:00 PM EST, with potential overtime hours typically between 7:00 AM and 6:00 PM EST
• Must successfully complete the required background check through Orange Tree, including criminal screening, before starting
• Client-provided equipment will be supplied for the remote position
• Must be able to work effectively in a remote contact-center environment
• Bilingual candidates must demonstrate proficiency in English and Spanish for bilingual positions