Eligibility Specialist Lead

Jefferson Health; Golden (CO); Hybrid; USD 40,000 - 42,000; Full time

Benefits offered by this job

Dental insurance

Medical insurance

Vision insurance

PTO & holidays

Retirement matching

Wellness programs

Tuition reimbursement

Flexible schedules

Remote work options

Job summary

Jefferson Health is seeking an Eligibility Specialist Lead to determine eligibility for Adult Financial and Medical Assistance, Food Assistance, Family Medical, Colorado Child Care, and Colorado Works. You will interpret regulations, support staff, and serve as a CBMS technical expert while training teammates and guiding QA processes.

The role offers hybrid work with remote and in-office days, a 40-hour week, and a competitive benefits package including retirement matching and tuition

Qualifications

• Experience interpreting eligibility rules and applying program policies.
• Ability to provide training and technical guidance.
• Experience with CBMS or similar eligibility systems.

Responsibilities

• Assist supervisors in monitoring and assisting eligibility staff with determinations.
• Provide technical guidance and interpret program rules and policies.
• Troubleshoot CBMS system errors and resolve issues.
• Assist staff with complex cases and questions to ensure compliance.
• Communicate changes to program rules to support consistent implementation.
• Share case review findings and lessons learned with staff.

Job description

Division: Community Assistance Division

Management Level: Individual Contributor

Scheduled Weekly Hours: 40

Benefit Eligibility: This position is eligible for Standard Benefits which includes dental, medical, and vision insurance, paid time off and holidays, retirement matching, wellness programs, and tuition reimbursement.

JOB DESCRIPTION SUMMARY:

The Eligibility Specialist Lead determines eligibility for the following programs: Adult Financial and Medical Assistance, Food Assistance, Family Medical, Colorado Child Care Assistance, and Colorado Works. The Lead Worker interprets and applies county, state and federal regulations, and assists Eligibility Specialists and Supervisors, as well as other staff within the department. This individual also serves as a technical expert in functions of the Colorado Benefits Management System (CBMS). The Eligibility Specialist Lead assists with training, reviews eligibility specialists work assignments, and provides backup support to team members when a supervisor is not available. The Eligibility Specialist Lead gathers information for all state reports and assists in managing the team's caseload.

SCHEDULE:

• 5/8s (8-hour workdays, Monday-Friday)
• 4/10s (10-hour workdays, any combination of days Monday-Friday)
• Hybrid: remote work and in-office work assigned as needed.

COMPENSATION:

• Hiring Range: $28.90-$30.34 USD Hourly
• Compensation will be determined based on education, experience and skills.

BENEFITS:

• medical, dental, and vision insurance
• paid time off and holidays, including a starting bank of 40 hours of PTO for new hires
• retirement matching
• wellness programs
• tuition reimbursement
• flexible schedules
• remote work options
• and more.

For more information, click here for our Total Rewards summary.

ESSENTIAL DUTIES:

Eligibility Program Support and Technical Guidance

• Support supervisors in monitoring and assisting eligibility staff with the determination and redetermination of eligibility across multiple assistance programs.
• Provide technical guidance and interpret program rules, regulations, and policies to support accurate, consistent, and timely eligibility determinations.
• Troubleshoot eligibility system errors within CBMS and identify appropriate courses of action to resolve system-related issues.
• Assist staff with complex cases, eligibility questions, and procedural concerns to promote compliance with federal, state, and county requirements.
• Interpret and communicate changes to program rules, regulations, policies, and procedures to support consistent implementation across the division.

Quality Assurance and Case Review

• Conduct consistent, timely, and meaningful case reviews to assess accuracy, compliance, documentation, and adherence to established eligibility policies and procedures.
• Document all completed case reviews in the designated QA database to support quality tracking, identification of trends, and evaluation of opportunities for additional coaching and training.
• Identify errors, patterns, and areas for improvement through case reviews and provide constructive, actionable feedback that supports employee development and continuous improvement.
• Collaborate with peers, supervisors, Quality Assurance (QA), and Training staff to promote consistent interpretation and application of quality standards across CAD.
• Seek clarification when questions arise regarding error findings, quality expectations, or policy interpretation. Bring unresolved questions and differing perspectives to Quality and Training Excellence (QTE) meetings to support shared understanding and consistent practices.
• Share case review findings, emerging trends, and lessons learned with appropriate staff to strengthen program knowledge, improve accuracy, and support consistent eligibility outcomes.

Employee Training, Mentoring, and Development

• Train, mentor, and provide ongoing technical support to new and established employees to strengthen program knowledge, system proficiency, and job performance.
• Provide guidance and constructive feedback to staff regarding case processing, documentation, application of policy, and quality expectations.
• Support staff development by identifying learning opportunities and collaborating with supervisors, QA, and Training to address knowledge gaps and recurring errors.
• Promote a culture of continuous learning, collaboration, accountability, and shared responsibility for quality outcomes.

Customer Service and Issue Resolution

• Assist customers with completing forms and submitting documentation necessary to process applications and maintain eligibility.
• Request, review, and verify information necessary to establish or continue eligibility based on applicable financial and non-financial criteria.
• Assist in resolving