Eligibility and Coverage Services Coordinator II

State of Oklahoma; Oklahoma; On-site; USD 30,000 - 33,000; Full time

Benefits offered by this job

State benefits

Insurance plans

FSAs

Retirement plan

Holidays

Paid vacation/sick leave

Longevity bonus

Loan forgiveness

Wellness on-site gym

Job summary

The Oklahoma Health Care Authority is seeking an Eligibility and Coverage Services Coordinator II to support SoonerCare and Medicaid programs. You will resolve inquiries, process claims, manage enrollments, and ensure policy compliance, delivering high-quality service to internal and external stakeholders.

The role emphasizes clear communication, attention to detail, and the ability to operate within evolving program guidelines while collaborating with other departments and maintaining organized

Qualifications

• Understanding of Medicaid program policies and procedures.
• Strong written and verbal communication skills.
• Ability to navigate complex program guidelines and maintain service quality.

Responsibilities

• Resolve member and provider inquiries and denied claims.
• Investigate access to care issues, fraud, abuse, and quality concerns.
• Educate on SoonerCare policies to providers and members.
• Process and reconcile electronic claims and enrollments.

Skills

Medicaid policies

Communication

Administrative processes

Education

Equivalent combination of education and experience

Job description

Eligibility and Coverage Services Coordinator II

Agency: 807 HEALTH CARE AUTHORITY

Full time, Regular

Compensation $22.81875/hour

Why you’ll love working here

At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values, Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership, we foster a workplace where people feel supported, respected, and empowered to make an impact. Learn more about OHCA.

Let’s talk benefits

• Generous state-paid benefit allowance to offset insurance premiums.
• A wide selection of insurance plans with no pre-existing condition exclusions.
• Flexible Spending Accounts for health care and dependent care.
• Retirement Savings Plan with employer contributions.
• 11 paid holidays annually.
• 15 days of vacation and 15 days of sick leave in the first year.
• Longevity Bonus recognizing years of public service.
• Public Service Loan Forgiveness eligibility and tuition reimbursement.
• Wellness benefits, including an on-site gym and fitness center discounts.

Job Description

Location: 4345 N Lincoln Blvd, Oklahoma City, OK 73105

Salary: $22.81875/hour

Work Schedule: Monday – Friday

Primary Hours: 8:00 a.m. – 5:00 p.m.

Agency/Division information

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency’s core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office.

Position purpose

The ECS Coordinator II plays a critical role in supporting the Oklahoma Health Care Authority's mission by ensuring efficient and effective administration of SoonerCare and other Medicaid programs. This position is responsible for resolving member and provider inquiries, processing claims, managing member enrollments, and maintaining compliance with program policies. The role requires strong communication skills, attention to detail, and the ability to navigate complex program guidelines, all while maintaining a high standard of service to internal and external stakeholders.

Essential functions may include

• Research and resolve provider and member inquiries, complaints, and denied claims.
• Investigate and address access to care issues, fraud, abuse, and quality assurance complaints.
• Interpret and communicate SoonerCare policies and procedures to providers, members, and stakeholders.
• Educate on program coverage, services, and eligibility guidelines for SoonerCare, BCC, DOC Inpatient, TEFRA, and Insure OK programs.
• Process and resolve electronic claims inquiries and claims reconciliation.
• Manage member applications, enrollments, plan changes, and eligibility verifications.
• Identify and report system discrepancies.
• Research and implement system updates and corrections.
• Stay current on SoonerCare rule revisions and program changes.
• Maintain organized reference materials and update written controls.
• Coordinate with other departments on referral issues and operational procedures.
• Communicate independently with members and stakeholders to resolve issues.
• Participate in special projects, member outreach, and educational efforts.
• Represent OHCA in meetings, seminars, and training forums.
• Support workflow during staff absences and manage high call volumes.
• Other duties as assigned.

Knowledge, skills, abilities and competency requirements

The ECS Coordinator II requires in-depth knowledge of Medicaid program policies, strong communication skills for resolving inquiries, and the ability to manage complex administrative processes. This role demands attention to detail, effective collaboration, and the ability to navigate both member and provider concerns. The Korn Ferry competencies that align well with this position are Manages Complexity, for handling detailed program and policy administration, and Collaborates, for working effectively with both internal and external stakeholders to resolve issues and ensure program success.

• To be considered for this position your application must include a resume/CV with complete work and education history.

Education and/or experience

• 1 year of experience in clerical office work or as a customer services representative plus 2 years of experience in customer service, processing tax returns, bookkeeping or closely related work OR
• An equivalent combination of education and experience, substituting thirty semester hours of college, including six semester hours in business or public administration for the required experience plus 2 years of experience in customer service, processing tax returns, bookkeeping or closely related work.

Preference qualifications include

• Certifications in any of the following areas: Certified Medicaid Professional (CMP), Customer Service or Call Center Management Certification, Project Management Certification (PMP), Lean Six Sigma Certification, Certified Health Data Analyst (CHDA), or Health Insurance Portability and Accountability Act (HIPAA) Certification

Physical demands and work environment

Work is typically performed in an office setting with climate-controlled settings and exposure to moderate noise levels. In the course of performing job duties, employees are required to speak, stand, walk, and reach with their hands and arms. This position requires extended periods of sitting and daily use of computers and phones. Employees must be willing to complete all job-related travel associated with this position. Being present at the office is an essential function of this position.

Accommodation statement

The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335.

Equal opportunity employment

The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.

Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.