Counselor-Enroll/Elig

SGS Consulting; Yorktown (VA); Remote; USD 60.000 - 75.000; Vollzeit

Zusammenfassung

SGS Consulting in Virginia seeks a Medicaid Eligibility Specialist to process complex cases, assist clients, and support training teams in a remote environment. You will apply policies accurately and coordinate with management to ensure timely, quality outcomes.

The role requires strong attention to detail, bilingual English/Spanish abilities, and 4+ years of relevant experience. A wired home internet connection and ability to work full-time are essential.

Qualifikationen

• High school diploma or GED required, with proof of completion.
• 4+ years of relevant professional experience required, or an equivalent combination.
• Associate degree with 2+ years of relevant experience preferred.
• Must be legally able to work remotely from Virginia.
• Reliable wired home internet service; Speedtest proof may be requested.

Aufgaben

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

Kenntnisse

Customer service

Attention to detail

Time management

Independent work

Team collaboration

Remote work

Bilingual English/Spanish

Ausbildung

High school diploma or GED

Associate degree (preferred)

4+ years relevant experience

Jobbeschreibung

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, 8:0 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