Customer Service Rep

SGS Consulting; Virginia Beach (VA); On-site; USD 42,000 - 62,000; Full time

Job summary

SGS Consulting in Virginia Beach is seeking a detail-oriented Medicaid eligibility specialist to join our team.

You will handle eligibility cases, assist with appeals, and act as SME on policies, while coordinating with project managers and training new hires. The role emphasizes accuracy, documentation, and compliance with program guidelines.

Qualifications

• High School Diploma or GED is required.
• Associate Degree is preferred.
• Minimum 4+ years of relevant professional experience, or an equivalent combination of education and experience.
• Candidates with an Associate Degree and 2+ years of relevant experience are preferred.

Responsibilities

• Process specialized Medicaid eligibility cases with a high degree of accuracy.
• Research and process appeals as assigned by supervisors.
• Serve as a Subject Matter Expert (SME) on eligibility policies and processes.
• Create and maintain work plan documentation.
• Track project status and due dates.
• Collaborate with project managers on various initiatives.
• Support training teams by assisting new hires during sandbox and transition periods.
• Ensure compliance with program policies and procedures.

Skills

Medicaid eligibility

Case management

Appeals processing

Microsoft Office

Research & analytical skills

Strong communication

English proficiency

Bilingual Spanish

Education

High School Diploma or GED

Associate Degree preferred

Minimum 4+ years of relevant experience

Tools

Microsoft Office

Job description

Job Responsibilities:

• Process specialized Medicaid eligibility cases with a high degree of accuracy.
• Research and process appeals as assigned by supervisors.
• Serve as a Subject Matter Expert (SME) on eligibility policies and processes.
• Create and maintain work plan documentation.
• Track project status and due dates.
• Collaborate with project managers on various initiatives.
• Support training teams by assisting new hires during sandbox and transition periods.
• Ensure compliance with program policies and procedures.

Skills:

• Medicaid eligibility and enrollment knowledge
• Case management
• Appeals processing
• Microsoft Office (Word, Excel, Outlook)
• Basic computer navigation
• Research and analytical skills
• Strong communication and organizational skills
• English proficiency required
• Bilingual (English/Spanish) preferred for bilingual positions

Education/Experience:

• High School Diploma or GED required.
• Associate Degree preferred.
• Minimum 4+ years of relevant professional experience required, or an equivalent combination of education and experience.
• Candidates with an Associate Degree and 2+ years of relevant experience are preferred.